University  of  California  •  Berkeley 


THE  LIBRARY 

OF 

THE  UNIVERSITY 
OF  CALIFORNIA 


PRESENTED  BY 

PROF.  CHARLES  A.  KOFOID  AND 
MRS.  PRUDENCE  W.  KOFOID 

W'    %$& 

1797       Ko^okf 

JW36921 5 


A 

TREATISE 

ON    THE 

STRUCTURE,    ECONOMY, 

AND 

DISEASES 

OF    THE 

LIVER; 

TOGETHER    WITH 

AN  INQUIRY  INTO  THE  PROPERTIES 


COMPONENT  PARTS 

OF    THE 

BILE  AND  BILIARY  CONCRETIONS. 

B  y 
WILLIAM  SAUNDERS,  M.D.  F.R.S. 

FELLOW-OF  THE   COLLEGE  OF  PHYSICIANS, 


FIRST  AMERICAN,     FROM  SECOND    LONDON  EDITION, 
WITH    CONSIDERABLE    ADDITIONS. 


BOSTON  : 

PRINTED  FOR  W.  PELHAM  N°  59  CORNHILL, 


\Price  One  Dollar,] 


PREFACE. 


JL  H  E  former  edition  of  the  follow- 
ing fheets  has  met  with  a  fale  which  far 
exceeded  the  Author's  expectations. 
The  refpecTful  notice  which  has  been 
taken  of  the  wrork,  by  Gentlemen  of 
the  firft  rank  in  the  profeffion,  anJ 
whofe  approbation  and  efteem  he  muft 
ever  be  proud  to  acknowledge,  toge- 
ther with  the  favourable  manner  in 
which  it  has  been  received  in  the  vari- 
ous critical  periodical  publications,  have 
induced  him  to  extend  his  inquiries 
and  obfervations  upon  the  fubjeft  ftii 
a  2 


IV  PREFACE. 

farther,  and  to  prepare  a  fecond  edition 
for  the  prefs. 

THE  attention  which  his  book  has 
excited,  has  been  the  occafion  of  his 
being  frequently  confulted,  and  of 
bringing  many  cafes  under  his  review, 
which  have  enabled  him  to  extend  his 
practical  obfervations,  and  to  obferve 
the  variety  of  fymptoms  which  occur 
in  the  different  ftages  of  thole  difeafes 
in  which  the  liver  is  the  organ  chiefly 


INDEED,  fo  general  is  the  influence 
of  the  different  functions  of  this  vifcus, 
that  any  derangement  of  them  may  be 
expected  to  have  a  confiderable  efFe6l  on 
various  other  organs.  Probably  many 
'complaints,  which  the  patient  is  ready 
to  refer  to  the  organs  of  refpiration,  to 
the  ftomach,  or  other  parts  of  the  ali- 
mentary canal,  may  have  their  fource 
in  a  morbid  ftate  of  this  organ* 


PREFACE. 


THE  accumulation  of  bile  in  the 
liver  and  gall-bladder,  producing  a  tur- 
gefcent  ftate  of  that  organ,  and  per- 
haps occafioning  a  congeftion  in  the 
large  blood  veffels  of  the  abdomen, 
may  be  the  frequent  caufe  of  that  fpe- 
cies  of  apoplexy  which  is  beft  cured  by 
purgatives,  and  fuch  other  means  as 
promote  the  evacuation  of  bile.  It  is 
probable  likewife,  that  the  good  effeds 
perceived  from  the  operation  of  aflive 
purgatives  in  the  early  ftages  of  acute 
difeafes,  and  the  advantages  ariflng 
from  fpontaneous  or  even  artificial 
diarrhoea  in  the  more  advanced  ftages 
of  them,  chiefly  depend  on  the  hepatic 
fyftem  being  kept  pervious,  fo  frequent- 
ly the  feat  of  dangerous  fevers.  Some 
arTedtions  of  the  mind,  it  is  alfo  proba- 
ble, may  be  intimately  connected  with 
fuch  a  ftate  of  the  liver. 


VI  PREFACE. 

NOT  only  by  his  own  obfervation, 
bat  alfo  by  the  correfpondence  which 
he  has  had  with  Gentlemen  of  the  pro- 
feilion,  who  have  feen  the  hepatitis  in 
the  Eaft  Indies,  he  is  more  fully  con- 
firmed in  the  propriety  of  the  treat- 
ment he  has  recommended  in  the  firft 
ftage  of  that  difeafe.  He  muft  ftill, 
therefore,  conllder  the  antiphlogiftic 
practice,  there  fpecified,  as  the  moft 
likely  to  fucceed  ;  and  with  all  his  par- 
tiality for  the  ufe  of  mercury,  in  the 
more  advanced  ftages  of  the  difeafe, 
and  even  before  the  inflammatory 
fymptoms  have  fubfided,  he  thinks  that 
too  early  an  application  of  it  has  been 
attended  with  difagreeable  effefts. 

THAT  he  poffefles  no  prejudices 
againft  this  important  article  of  the 
Materia  Medica,  will  appear  clearly, 


PREFACE.  VII 

when  the  reader  difcovers  the  attention 
he  has  paid  to  the  different  modes  of  ex- 
hibiting it  in  fome  difeafes  arifingfrom 
an  affedion  of  this  organ.  In  a  Hate 
of  the  liver,  approaching  to  fchirrus, 
he  confiders  it  as  the  only  medicine 
to  be  depended  upon  ;  and  more  than 
this,  in  other  difeafe^,  fuch  as  diarrhoea 
and  dyfentery,  which  he  confiders 
as  having  frequently  a  reference  to 
fuch  a  ftate  of  the  organ.,  he  has  experi- 
enced confiderable  advantage  from  the 
ufeof  it. 

BEING  confulted  by  many  patients 
labouring  under  afcites,  and  other  fpe- 
cies  of  dropfy,  he  has  frequently  been 
able  to  trace  the  fource  of  thefe  difeafes 
to  fome  morbid  ftate  of  the  liver.  The 
Author  has,  therefore,  improved  this 
edition  by  giving  fome  explanation  on 


Vlll  PREFACE. 

the  general  pathology  of  dropfy,  more 
efpecially,  however,  as  depending  on 
the  refiftance  to  the  tranfmiffion  of 
blood  through  the  venous  fyftem  of  the 
liver  ;  he  has  likewife  extended  his  in- 
quiries on  the  fubjed  of  diet,  and  the 
probable  influence  of  the  hepatic  fyf- 
tem on  the  procefs  of  digeftion. 

HE  cannot  conclude  this  Preface 
without  acknowledging  the  obligations 
he  has  to  Dr.  Haighton,  Lefturer  on 
Phyliology  and  Midwifery  at  Guy's 
Hofpital,  for  the  ingenuity  and  accura- 
cy with  which  he  has  planned  and  ex- 
ecuted the  various'  experiments  made 
on  brute  animals  for  the  purpofes  of 
explaining  and  corroborating  the  doc- 
trines advanced  in  this  treatife. 


CONTENTS, 


CHAP.    I. 

ANATOMICAL  DESCRIPTION  Or 
THE  LIVER. 


THE  Bile  fecreted  by  the  liver,  page  I.  Figure  of 
the  liver  not  effential  to  its  function,  but  determined 
by  that  of  the  animal,  2.  Its  figure  defcribed, 
ibid.  The  proportion  of  its  lobes  different  in  the 
foetus,  3.  Caufe  of  this  difference  is  the  umbili- 
cal vein,  4.  Its  fituation  defcribed,  ibid.  Differ-' 
ent  in  females,  and  in  the  foetus,  5.  Its  connexion 
to  the  diaphragm  by  ligaments  explained,  6.  Its 
fituation  with  refpeft  to  the  ftomach,  8.  The  gall« 
bladder,  its  fituation  defcribed,  ibid* 

CHAP.     II. 

yeffels  of  the  Liver,  page  1 1 . 

SECRETORY  organs  plentifully  furniflied  with  blood 

— The  fame  veffel  generally  carries  blood  both  for 

fecretion   and   nutrition — Hence    the    proportion 

devoted  to  each  purpofe  uncertain,    12.    In  the 


CONTENTS. 

liver  this  difficulty  is  removed,  ibid.  How  arterial 
blood  only  is  fit  for  nutrition,  ibid.  Origin  and 
branches  of  the  hepatic  artery,  13.  Its  ramifica- 
tion through  the  liver,  and  termination,  14.  Bile 
fecreted  by  venous  blood  carried  by  the  vena  por- 
tarum,  i^.  Origin  of  this  vein,  16.  Its  fuppofed 
ftrufture,  17.  GlifTon's  opinion  on  this  fubjecT:, 
ibid.  Its  ramification  and  termination,*  19.  Pori 
biliarii  and  hepatic  duel;,  20.  Its  mufcularity  con- 
fidered,  ibid.  Abforbents  fuperficial  and  deep 
feated,  22.  Their  origin  and  termination — Their 
communications,  ibid.  Their  valves  lefs  complete 
here  than  in  other  parts,  23.  May  be  injefted 
contrary  to  the  cour/e  of  their  contents,  24.  Nerves 
—-their  origin,  ilid. 


CHAP.    III. 

The  Nature  of  the  Blood  circulating  through 
the  Vena  Portarum  confidercd>  page  27. 

VENOUS  blood  more  favourable  for  the  fecretion  of 
bile  than  arterial — but  in  what  refpeft  the  blood  of 
the  vena  portarum  differs  from  other  venous  blood 
is  a  defideratum,  28.  The  fubferviency  of  the 
fpleen  to  the  ceconomy  of  the  liver  confidered,  29. 
The  arguments  by  which  it  is  fupported  are  exa- 
mined, firft,  the  fplenic  blood  is  poured  into  the 
vena  portarum,  30.  Second,  the  changes  it  is  fup- 


CONTENTS.  XI 

pofed  to  receive,  during  its  paflage  through  the 
fpleen,  31.  Experimental  inveftigation  of  this 
fubjecl: — Blood  from  the  fplenic  vein  not  more  fluid 
than  other  blood,  nor  more  putrefcent,  32.  Bile, 
fecreted  after  the  fpleen  is  taken  out,  compared 
with  other  bile,  36.  No  fenfible  difference,  37. 
Hence  the  liver  is  independent  on  the  fpleen,  ibid. 
A  reflexion  drawn  from  experimental  inquiry,  37. 
Animadverfions  on  venous  blood  as  being  better 
adapted  to  the  biliary  fecretion  then  arterial,  38. 
Arguments  favouring  this  opinion  drawn  from  the 
foetus,  39. 


CHAP.     IV. 

Of  the  Hepatic  Artery y  and  the  Office  of  the 
Blood  which  it  contains,  page  41. 

DIFFERENT  opinions  on  this  fubjecl:,  ibid. — Whe- 
ther an  auxiliary  to  the  vena  portarum,  41.  The 
grounds  of  this  opinion  as  founded  on  a  fuppofed 
analogy  between  the  liver  and  lungs,  42.  The 
analogy  difproved,  45.  The  communication  of 
veflels  fuppofed  to  be  favourable  to  this  do6brine, 
46.  In  what  refpecl  the  artery  may  be  faid  to 
communicate  with  the  duel:,  47.  No  conclufion 
to  be  drawn  from  thefe  fa£ls,  ibid.  The  capacity 
•f  the  hepatic  arteiy  compared  with  the  bulk  of 


Xll  CONTENTS. 

the  liver  confidered,  48.  The  proportion  between 
mufcles  and  the  arteries  that  fupply  them,  ibid. 
Tendons  compared  with  their  arteries,  49.  The 
brain  with  its  arteries,  ib.  All  thefe  parts  are  nou- 
rifhed,  but  require  different  proportions  of  blood 
for  their  actions,  ,50.  The  action  of  a  fecreting 
organ  fuppofes  great  vital  energy,  ibid. — hence 
much  blood,  ibid.  An  extraordinary  lufus  na- 
turas,  note,  ibid. 

CHAP.    V. 

Interior  Structure  of  the  Liver,  page  53. 

IN  what  part  of  the  liver  is  fecretion  performed — 
Terminations  of  the  vena  portarum,  ibid.  Reafons 
for  thinking  the  fecretion  is  performed  in  the  mofl 
minute  veflels,  54,  How  far  fecretion  depends  on 
any  peculiar  arrangements  of  parts,  55.  The 
opinions  of  Malpighi  and  Ruyfch  ftated,  ibid.  Ap- 
pearances like  cryptae  in  the  liver,  56.  Alfo  in 
the  kidney,  57. 

CHAP.     VI. 

Courfe  of  the  Bile,  page  59. 

FROM  the  pori  biliarii  to  the  trunk  of  the  hepatic 
duel,  ibid.  Its  properties  changed  by  the  abfor- 
bents,  60.  Its  paffage  into  the  duodenum  fubjecl: 


CONTENTS.  X11I 

to  interruption,  ibid.     EfFecT:  of  this  on  the  gall- 
bladder, 61.     Gall  bladder,  its  contents  and  ufe, 

62.  The  common  opinion  doubted  by  Albinus, 

63.  The  exiftence  of  hepatico-cyflic  duels  in  the 
human  fubjecl:,  difproved,  65.     Further  confider- 
ations  on  the  ceconomy  of  the  gall  bladder,  ibid.  Is 
itapafTive  receptacle  ?  67.     The  affirmative  argu- 
ed for  from  analogy,  ibid.     It  is  not  vifibly  mufcu- 
lar,  68.     Nor  irritable  on  the  application  of  ilimu- 
li ;  therefore  a  paflive  receptacle,   ib.     Regurgita- 
tion  of  bile  from  the  intefline  by  the  duel  how  pre- 
vented, 69.     The  caufcs  impeding  the  flow  of  bile 
into  the  inteftine,  70.     Permanent   ilruclurc,  ibid. 
Spafm  doubtful,  except  at  the  termination  of  the 
duel:,  71.     Preffure  from  fchirrous  ftate  of  the  pan- 
creas, 72.     Sc.hirrous  impacted  liver,  ibid.     Jaun- 
dice not  always  conne6ted  with  obftruclion  in  the 
biliary  duels,  proved  by  the  yellow  fever,  73.    Mor- 
gagni  and  Boerhaave's  opinion  of  jaundice,  arifing 
from   obftrufted   fecretion,   confidered,  ibid.     By 
what  channels  the  bile  paries  into  the  blood,  7^. 
Haller's  opinion  by  regurgitation,  76.      Abforp- 
tion  confidered,  77.     Is  jaundice  produced  both  by 
regurgitation  and  abforption  ?  .78.     That  the  ab- 
ibrbents  take  up  the  bile  is  proved  by  experiment, 
ibid.     But  does  not  regurgitation  likewife  concur  ? 
79.     The  affirmative  proved  by  experiment,  ibid. 
Inference,  80. 

* 


XIV  CONTENTS. 


CHAP.    VII. 
Bile,  page  83. 

ITS  colour,  varies  by  dilution,  ibid.  Confidence,  84* 
Vifcidity,  perhaps  not  eflential,  ibid.  A  fapona- 
ceous  fluid,  ibid.  Has  a  bitter  tafte  and  faint  nau- 
feous  fmell,  85.  Conjectures  on  its  conflituent 
parts  drawn  from  its  fenfible  properties,  ib.  The 
ancient  mode  of  investigation  by  heat  alone,  inade- 
.quate,  ,86.  The  moil  natural  examination,  by 
chymical  attractions,  87.  ^Gentle  evaporation  diffi*- 
pates  the  odorous  principle  along  with  the  water— 
-the  refiduum  folid  and  brittle,  88.  Its  vifcidity 
depends  on  an  animal  mucilage,  90.  The  effe£ls 
of  mineral  acids,  ibid.  More  itrongly  marked 
when  afTifled  by  heat,  91.  They  effect  the  de- 
compofition  by  engaging  the  alkaline  principle,  92. 
Proofs  of  this,  93.  No  common  fait  pre-exifts  in 
the  bile,  but  only  its  alkaline  bafis,  ibid.  Its  colour 
and  tafte  re  fide  in  a  refmous  principle,  95.  Proofs, 
96.  Recapitulation,  ibid.  Its  antifeptic  proper- 
ties confidered,  97.  ' 


CHAP.     VIII. 

On  Biliary  Calculi,  page  99. 

EXTERNAL  characters,  and  fenfible  properties  are 
various,  ibid.     Therefore  not  mere  infpiffations  of 


CONTENTS.  XV 

bile,  100.  Different  fpecimens  mould  be  examin- 
ed, 101.  An  inquiry  into  the  conftituent  parts  of 
a  calculus,  ibid.  Its  fenfible  properties,  102. 
Relative  folubility  in  ol.  terebinth  and  alcohol — 
leaves  an  earthy  refiduum,  104.  Much  refmous 
matter,  105.  Inquiry  into  the  preferice  of  an 
alkali,  ibid.  The  mineral  and  volatile  alkali  de- 
tected, 106* 


CHAP.     IX. 
Of  the  Ufe  of  tbe  Bile,    page  109. 

THE  probability  of  a  connexion  between  red  blood 
and  the  bile,  ibid.  The  fubferviency  of  bile  to 
chylification,  confidered,  no.  The  refult  of  ex- 
periment not  favourable  to  that  opinion,  in.  Nor 
its  probability  ftrengthened  by  the  fymptoms  of 
jaundice,  ibid.  Its  principal  ufe  is  that  of  a  ftimu- 
lus  to  the  inteftines,  112.  May  correct  acidity  in 
the  primae  vise  from  its  alkaline  principle,  113. 
And  re fi ft  a  tendency  to  fermentation,  ibid.  This 
corroborated  from  hypochondriafis  and  chlorofis, 
114.  When  defeftrve  may  be  fupplied  by  arti- 
ficial means,  ibid.  Its  defecl:  more  productive  of 
difeafe  than  its  excefs,  115.  Is  antifeptic  from  its 
bitternefs,  ibid. 


XVI 


CONTENTS. 


OF  THE  DISEASES   OF  THE  LIVER, 

DEPENDING    ON    ITS     FUNCTION 

AS  AN  ORGAN  OF  SECRETION. 


CHAP.    I. 
Of  the  increased  Secretion  of  Bile,  page  117. 

EXCESSIVE  fecretion  of  bile  the  endemia  of  warm 
climates  —  Its  effecls  and  fymptoms,  ibid.  A 
change  of  climate  advantageous,  118.  Lefs'dif- 
treffing  to  natives  than  foreigners,  119.  Bile  more 
antif  .y  ic  in  warm  climates  than  in  cold, .  120.  Ob- 
ftinate  difeafes  conne6:ted  more  frequently  with  a 
defect  of  bile,  than  its  excefs,  121.  Diluents  advan- 
tageous, 123.  Internal  ufe  of  warm  water  confider- 
e&,ibid.  Bath,  Briftol,  and  Buxton  waters  pro- 
bably act  on  this  principle,  124.  In  profufe  biliary 
fecretions,  emetics  are  improper,  125.  Chelten- 
ham water,  obfervations  on  its  ufe,  126.  Regimen 
for  bilious  habits,  128.  Cholera  morbus,  a  def- 


CONTENTS.  XV11 

cfiption  of,  ibid.    The  bile  appears  to  be  imperfect, 
129.     Cure  131. 


CHAP.   II. 

Of  the    dimini/hed  Secretion  of  Bile, 
page   135. 

THIS  fometimes  depends  on  chronic  inflammation  of 
the  liver,  136.  Its  fymptoms,  ibid.  Connected 
with  the  ftomach,  137.  Proper  regimen  in  fuch 
cafes,  138.  The  temporary  lofs  of  bile,  how 
fupplied,  143.  The  tendency  of  bile  to  correct 
acidity  in  the  primae  vise,  (Note).  The  ufe  of  mer- 
cury confidered,  144.  Other  modes  of  treat- 
ment, 147. 


CHAP.  III. 

Of  Obftruftion  to  the  free  Paflage  of  Bile  into  the 
Duodenum,  page    151. 

JAUNDICE,  152.  Definition,  ibid.  Hiftory,  ibid. 
Decline,  1,53.  Appearances  on  difie&ion,  155. 
Diftinguimed  from  chlorofis,  156.  And  the  en- 
demic fever  of  the  Weft  Indies,  137.  Influence  of 


XV111  CONTENTS. 

thepaflions  on  the  biliary  fecretion,  158.  Bile  is 
imperfect  when  the  fecretion  is  hurried,  ibid.  A 
fedentary  life  difpofes  to  jaundice,  &c.  159.  Alfo 
the  abufe  of  fpirituous  liquors,  161.  Obfervations 
on  the  biliary  dufts,  162.  And  on  calculi  as  pafs- 
ing  through  them,  164.  PrefTure  on  the  duels,  a 
caufe  of  jaundice,  166.  Prognofis,  168.  Cure, 
169.  By  folvents  impracticable,  ibid.  Emetics, 
their  ufe,  170.  Purgative  medicines,  bitters,  &c. 
ibid.  Exercife,  171.  Mr.  Dick's  treatment  of 
jaundice  by  calomel,  (a  Note).  His  obfervations 
on  the  ufe  of  mercury  in  hepatitis,  172. 


CHAP.     IV. 

Of  the  Difeafes  to  which  the  Liver  is  Jubjeft  in 
common  with  other  Organs  of  a  glandular 
Structure,  page  175. 

LIVER  fubjeft  to  acute  and  chronic  inflammation, 
ibid.  Hepatitis,  fymptoms  of,  176.  Symptoms 
vary  from  the  part  of  the  liver  attached,  177. 
Diftinguifhed  from  other  complaints,  ibid*  Sto- 
mach affefted  fympathetically,  ibid.  Hepatitis, 
its  termination  in  fuppuration,  178.  Thefe  ab- 
fcefles  not  always  vifible  externally,  but  difcharge 
themfelves  internally,  179.  In  what  fenfe  the  bili- 
ary du£ls  can  convey  the  matter  into  the  duodenum  r 


CONTENTS.  XIX 

ibid.  Immediate  communication  with  inteftiries 
more  frequent,  180.  The  precife  part  varies  with 
the  particular  feat  of  the  abfcefs,  181.  Hepatitis 
fometimes  confounded  with  peripneumony,  183. 
Alfo  with  inflammation  of  the  itomach,  ibid.  Fa- 
vourable termination  of,  184.  Has  corroded  large 
blood  vefTels,  185.  Sometimes  terminates  by  me- 
taftaiis,  ibid.  Suppurativefyinptomsof,  not  always 
.evident,  ib.  Sometimes  ends  in  gangrene,  186.. 
Often  terminates  in  a  fchirrous,  ib.  Schirrous  liver 
fometimes  miftaken  for  dyfpepfia,  how  diftinguifh- 
ed,  187.  Schirrous  liver,  fymptoms  of,  appear- 
ances on  diffetlion,  190.  Explained,  191.  Proxi- 
mate caufe  of  hepatitis  inveftigated  by  analogy,  192. 
The  veflels  may  be  in  two  oppofite  ftates,  (viz.)  one 
a£Uve,  the  other  pafiive,  193.  Application  of  this, 
198.  How  an  active  inflammation  may  degenerate 
into  an  indolent  one,  199.  The  operation  of  re- 
mote caufes,  200.  Some  curative  indications  de- 
duced, 201.  Dropfy,  its  caufes  and  connexion 
with  difeafes  of  the  liver  confidered,  203  (a  Note). 
Tubercular  ftate  of  the  liver,  204.  Their  forma- 
tion explained,  205.  The  particular  feat  of  aftive 
and  indolent  inflammations  confidered,  212.  Cure 
of  the  a£Hve  inflammation  in  its  firfl  ftage,  213. 
Blood-letting,  214.  Blifters,  215.  Laxative  medi- 
cines, 216.  Antimonials  and  diluents,  ibid.  Ne- 
ceflity  for  the  antiphlogiftic  plan  particularly  urgent 
in  warm  climates,  217.  When  fuppuration  fol- 
lows^ the  matter  efcapes  by  different  outlets,  218, 


XX  CONTENTS. 

Duodenum,  colon,  lungs,  integuments,  219.  This 
conformable  to  a  law  of  nature,  ibid.  Thefe  out- 
lets not  equally  favourable  to  the  patient,  220. 
Lungs  lefs  fo  than  inteftines,  or  the  integuments, 
ibid.  The  pus  feldom  efifufes  into  the  abdomen, 
221.  May  be  difcharged  by  lancet,  ibid.  Slow, 
but  progreflive  return  of  health,  222.  Explanatory 
remarks,  ibid.  Confiderations  on  the  ufe  of  mer- 
cury, 'ibid.  Its  exhibition,  how  regulated  in  the 
Eaft  Indies,  225.  Its  aftion  in  fchirrous  liver 
further  confidered,  226.  Its  application  to  the 
vicinity  of  the  liver  not  particularly  advantageous, 

227.  No  dire£l  communication  between  the  ab- 
forbents  of  the  (kin  and   liver,  ibid.     Abforption 
more  rapid  from  ulcerated  and  veficated  furfaces, 

228.  Mercury  not  detectable  in  the  fecretions  by 
chymical  tells,  ib.     The  connexion  between  fchir- 
rous liver  and  dyfentery,  229.     Conclufion,  230, 


CHAP.    I. 


ANATOMICAL   DESCRIPTION 

OF    THE 

LIVER. 


SECT.     I. 

JL  o  the  fecretion  of  the  bile  Nature  has 
deftined  an  organ  of  confiderable  fize,.  call- 
the  Liver  -,  its  magnitude  is  greater  than 
that  of  any  gland  in  the  body,  fo  that 
it  occupies  a  very  coniiderable  part  of 
the  abdominal  cavity. 

2.     ITS    figure    is    fomewhat    irregular, 
confequently  it  does  not  readily  admit,  of 


[      2      3 

companion  with  any  mathematical  figure ; 
it  is  unlike  any  body  with  which  we  are 
acquainted.  This  circumflance  of  the  liver 
is  perhaps  lefs  eflential  than  many  others, 
as  figure  does  not  appear  to  throw  any 
light  on  its  ceconomy.  At  leaic  we  na- 
turally incline  to  this  opinion,  from  tak- 
ing a  view  of  this  vifcns  in  different 
animals,  when  it  appears  that  the  external 
figure  cf  the  liver  ,is  determined  by  the 
figure  of  the  animal  itfelf,  or  that  parti- 
cular cavity  in  which  it  is  contained.  In 
the  human  fiibjecl:  it  is  fomewhat  flattifh 
and  convex  on  irs  anterior  furface,  irregular 
on  its  pofcerior,  having  feveral  depre/Tions  ; 
at  its  inferior  edge  there  is  a  fiflure  ex- 
tending fome  way  up,  particularly  on  its 
pofterior  furface,  which  forms  a  divifion 
into  two  lobes  of  unequal  fizcs.  Thefe, 
from  their  fituation  in  the.  abdominal  ca- 
vity, are  diftinguifhed  by  the  names  of 
right  and  left,  of  which  the  right  is  the 
lanjer.  Befides  thefe,  there  is  a  fmailer 


[     3     ] 

'obe,  fituated  at  the  fuperior  and  pofterior 
-jart,  called  Lobulus  Spigelii. 

3.  THOUGH   in  adult  fubjects  the  right 
obe   is  larger  than  the  left,  in  the  fcetus 

the  left  is  as  large  as  the  right.  This  varie- 
ty depends  on  the  difpofition  of  the  umbili- 
cal vein  in  the  fcetus  with  refpect  to  this 
organ  -3  for  on  its  arrival  at  that  gland,  it 
fends  off  feveral  branches,  fome  of  which, 
penetrating  the  left  lobe,  are  of  coniider- 
able  fize  ;  but  after  birth,  when  the  circu- 
lation takes  a  new  courfe,  the  whole  liver, 
but  more  efpecially  the  left  lobe,  dirmniOie* 
in  bulk. 

4.  BESIDES  this  variety  in  the  proportion 
of  its    lobes,   the    whole  foetal   liver    muft 
necefTarily  exceed  that  of   the  adult  in  pro- 
portion i  for,  in  addition  to  the  veflels  pro- 
per to  the  liver,  and  neceflary  to  its  cecono- 
my,  there  is  one  peculiar  to  the  fcetus,  viz. 
the  umbilical  vein.     This  vefTel,  which  has 

-  its  origin  in  the  placenta,   accompanies   th« 
other  veflels  of  the  cord,  and  perforates  the 


[     4     ] 

navel  ;  thence,  having  reached  the  inferior 
edge  of  the  liver,  it  pafies  along  the  fiffure 
which  feparates  the  lobes,  and,  having  en- 
tered its  fubflance,  fends  off  feveral  branches; 
thole  going  to  the  left  lobe  are  larger  and 
more  in  number  than  thofe  to  the  right. 
After  which  the  umbilical  vein  divides  into 
two  branches,  one  taking  the  courfe  of  the 
vena  cava,  called  canalis  venofus  ;  the 
other,  uniting  with  the  branch  of  the  vena 
portarum,  pours  its  blood  into  that  fyftem  ; 
fo  that  by  much  the  largeft  proportion  of 
the  blood  circulating  between  the  foetus 
and  the  placenta  pafles  through  the  liver, 
and  this  fufrkiently  explains  why  the  fcetal 
liver  exceeds  in  proportion  that  of  the  adult. 
5.  THIS  organ  is  fituated  in  the  fuperior 
part  of  abdomen,  principally  on  the  right 
fide,  occupies  the  epigaftric  and  the  right 
hypochondric  regions,  and  fometimes  ex- 
tends into  the  left  hypochondre.  Its  pre- 
cife  fituatton  cannot  be  eafily  determined, 
as  the  inferior  part  of  the  cheft  admits  of 


[     5     ] 

confiderable  variety  both  in  its  figure  and 
capacity.  In  males,  where  there  is  a  greater 
capacity  of  cheft,  the  hypochondres  arc 
more  capacious,  hence  the  epigaftric  and  the 
right  hypochondric  regions  are  large  enough 
to  contain  this  vifcus. 

6.  IM  females^  who  have  naturally  a 
final ler  cheft,  which  is  flill  more  contracted 
by  tight  lacing,  the  epigaHric  and  the  right 
hypochondric  regions  are  infuHicient  to  con- 
tain the  liver,  it  therefore  extends  far  into 
the  left  hypochondre  ;  befides,  which,  it 
fometimes,  in  theie  cafes,  occupies  no  in- 
confiderable  part  of  the  umbilical  region. 
Its  fituation,  then,  with  refpect  to  the  gene- 
ral cavity  of  the  abdomen,  admits  of  forne 
variety.  In  the  fetus,  it  occupies  the  whole 
epigaflric  region,  and  both  the  hypochon- 
dres y  not  lo  much  from  any  peculiarity  in 
the  figure  of  the  upper  part  of  the  abdo- 
men, as  from  a  difference  in  the  proportion 
of  the  right  and  left  lobe,  wnicii  has  already 
been  noticed. 

B3 


[     6     ] 

7-  THOUGH  the  fituation  and  extent 
of  the  liver,  in  the  general  cavity  of  the 
abdomen,  admit  of  fome  variety,  yet  its 
•pofition  with  refpect  to  the  diaphragm  is 
rather  precife,  being  connected  to  it  by 
doublings  of  the  peritonaeum,  called  liga- 
ments. 

8.  THIS  vifcus,  in  common  with  the 
others  of  this  cavity,  receives  a  cover; ng 
from  the  peritonaeum,  which,  doubling 
upon  itfelf,  and  quitting  the  liver,  is 
attached  to  the  diaphragm.  This  connec- 
tion obtaining  in  certain  parts,  forms 
the  ligaments.  The  moll  confpicuous  of 

*t 

which,  is  that  fituated  on  its  anterior  part, 
in  a  line  correfponding  to  the  fiffure, 
forming  the  diftinclion  between  the  right 
and  left  lobe,  which,  extending  from 
the  fuperior  to  the  inferior  edge,  is  call- 
ed by  fome,  from  its  refemblance  to  a 
fcythe,  the  FALCIFORM  ligament -,  by 
others,  from  its  function,  the  SUSPENSORY 
ligament. 


[    7    1 

o,.  THE  lateral  portions  of  the  liver  are 
connected  in  like  manner  to  the  corref- 
ponding  parts  of  the  diaphragm,  taking 
the  name  of  lateral  ligaments.  Befidcs 
which,  fome  anatomifts  reckon  the  por- 
tion of  peritonaeum  furrounding  the  veflels, 
which  pafs  from  this  vifcus  through  the 
diaphragm,  as  a  fourtli  ligament,  and  call 
it  the  coronary  ligament. 

By  ,  thefe  different  reflexions  of  the 
peritonaeum,  the  liver  is  fupported  in  its 
fituation. 

10.  BUT  there  is  yet  another  part, 
ufually  numbered  with  the  ligaments, 
which,  however,  performs  no  ligamento- 
ry  function,  viz.  the  the  ligamentum  rotun-' 
dum.*  This  pafles  from  the  concave  part 

*  The  ligamentum-  rotundum  has  already  been 
noticed  under  the  name  of  umbilical  vein,  of 
which  it  is  to  be  confidered  as  the  collapfed  re- 
mains:  for  after  the  circulation  through  it  has 
ceafed,  which  neceiFarily  happens  at  birth,  its 
cavity  diminishes,  and  in  time  becomes  nearly 
obliterated. 


C     8    ] 

of  the  liver  along  its  longitudinal    fuTure, 
and  is  continued  to  the  umbilicus. 

IT.  HENCE  in  the  living  fubjecl  the 
fituation  of  the  liver  mull  vary  with  refbcc~fc 
to  the  general  cavity,  according  as  the  dia- 
phragm defcends  or  afcends,  in  the  acts  of 
infpi ration  or  expiration. 

12.  THE  fituation  of  the    Pcomach    with 
refpect  to  this  organ  is  fuch,  that  the  right 
portion  of  the  former  is  frequently  covered 
by  the  left  lobe  of  the  latter,  and,  from  the 
bilious  tinge  frequently  found    oh  the  ex- 
ternal furface    of  the   duodenum    near   the 
pylorus,  it   appears    that   the    gall-bladder 
ufually  reds  on  this  part. 

13.  THE    gall-bladder   is    a    bag   fome- 
what   :;ynfcTm    in  its    fhnpe,    its    neck    or 
fmall   extremity   being  iituated    fuperiorly, 

its  fundus,  or  large  extremity,     infe- 

riorlv.     It  is  lodged  in  a  depreflion  on  the 

•  we   furface    of    the  right  lobe  of    the 

liver,  to  which  it  is  p.ttachvci.  by  a  cor-tinu- 

•ation  of  the  peritoneal  coat  of  thdu  v.icus 


[     9     ] 

over  its  furface.  It  varies  fomewhat  in  fize 
according  to  the  degree  of  diftention  which 
it  fuffers,  but,  in  moft  inflances,  the  fun- 
dus  projects  a  fmall  diftance  below  the  infe- 
rior edge  of  the  liver.  Deflined  by  Na- 
ture to  contain  bile,  it  has  a  duel  which 
both  receives  and  difcharges  it,  thececono- 
mv  of  which  will  be  confidered  hereafter. 


[  II  ] 


CHAP.     II. 


VESSELS  OF  THE  LIVER. 


SECT.   I. 


JL_JVERY  organ  deftined  by  Nature  to 
fecrete  a  fluid,  is  very  plentifully  fnrniihed 
with  blood.  The  riceefTity  of  this  is  evi- 
dent 5  for  it  requires,  not:  only  a  fupply  of 
that  fluid  for  thepurpofe  of  its  nourifnment, 
but  an  additional  quantity  alfo  to  enable  it 
to  perform  its  Decretory  functions;  as  it  is 
from  the  blood  that  all  the  fecretions  are 
derived. 

SUCH    is    the   ceconomy   of  Nature  in 
glandular  bodies  "in  general,  that  the  fame 


[      12      ] 

fluid  which  is  fit  for  the  nourifhment  of  the 
gland,  is  adapted  ajfo  to  its  fecretory  office, 
and  is  conveyed  to  the  organ  by  the  fame 
verTel.  But  the  phyfiologift  is  unable  to- 
afcertain,  with  any  degree  of  precifion,  how 
much  blood  is  allotted  to  nutrition,,  and 
how  much  to  fecretion. 

2.    OUR  knowledge  of  the  ceconomy  of 
Nature  in   this  refpect,  receives  fome  light 
from  a  peculiarity  which  obtains  in  the  li- 
ver,  and  which   diftinguiflies  it  in  a  very 
finking  manner  from  all  the  other  glands  in 
the  body.     For,   while  the  functions  of  nu- 
trition and  fecretion  are  in  them  combined 
in  the  fame  veflel,    in  this,  thefe  offices  are 
kept  apart,  and  performed  by  different  vef- 
fels.     Therefore,  by  a  judicious  comparifon 
of  the  area  of  the  nutrient  with  that  of  the 
fecreting  velTel,  we  may  readily  allot  to  each0 
its  due  proportion. — But  this  idea  will   be 
farther  purfued  hereafter. 

3.    BLOOD    of  every    defcription   is    not 
equally  fit  for  nutrition  :   that  only,  which 


C    <3 

has  received  the  change  from  respiration, 
and  which  circulates  through  the  arteries, 
is  well  adapted  to  this  purpofe,  therefore 
the  liver  receives  its  nutrimental  blood  from 
an  artery. 

4.  THE  rule  which  feems  to  guide  the 
conduct  of  Nature  in  the  origin  of  veflels 
fupplying  other  organs,  obtains  equally  in 
this,  as  the  hepatic   artery   arifes  from  the 
nearefl  confklerable  trunk. — The   following 
is  the  mode  of  its  origin  : 

5.  THE   Aorta,  while  it   is   paffing   be- 
tween the  crura  of  the  diaphragm,  fends  off, 
from   its   anterior  part,    three   confiderable 
azygous  trunks  :    the  firft  takes  the  name  of 
cceliac  artery  ;  the  fecond,    which  is  almoft 
immediately  under  the  former,  is  called  the 
fuperior  mefenteric ;    and  the  third,  going 
off  from  the  aorta  at  fome  diftance  from  the 
laft  veflel,   is  named  the  inferior  mefenteric 
artery  :  the  two  laft  fupply   the  inteftinal 

canal. 

c 


[     H     ] 

6.  THE    cceliac  trunk   foon  divides    into 
three  branches — the  firft,    being  diftributed 
to  the  lefTer  curvature  of  the  ftomach,   is  the 
coronary  artery;    the  fecond,  pafling  to  the 
left,  is  called  the   fplenic  artery  -,  and  the 
third,  or  largeft,   whofe  office  we  are  now  to 
confider,  takes  the  name  of  the  hepatic  artery. 

7.  THE  hepatic  artery,  at  its  origin,   is  a 
veflel  of  confiderable  fize,   but  before  it  ar- 
rives  at    the  liver  is  fenfibly  fmaller;    the 
caufe  of  which  is,   that  in  its  progrefs    it 
fupplies  adjacent  parts  with  blood,   viz.  the 
right    portion  of  the  flomach  by  means    of 
the  gaftrica   dextra  and  pylorica,    and  the 
gall  bladder  by  the  arteria  cyftica  ;  therefore 
in   forming  a  true  eftimate  of  the  quantity 
of  blood   fent  to  the  liver  for  its  nourifh- 
ment,  we  are  to  confider  the  area  of  the  hepa- 
tic artery,  after  the  three  preceding  branches 
are  fent  off. 

8.  THIS  veflel,  agreeably  to  the  general 
law  of  diftribution,  divides  into  branches 
before  it  enters  the  fubftance  of  the  liver; 


L    15    1 

its  ramifications  then  multiply  and  extend 
with  great  minutenefs  through  the  whole 
mafs  ;  fo  that  in  every  part  of  its  fubflance 
there  is  circulating  blood  pofTefied  of  pro- 
perties fit  for  nutrition.  But  as  this  blood 
is  in  a  (late  of  conftant  motion,  and  is  con- 
tinually  changing  by  fuccefiive  fupplies,  a 
redundancy  is  prevented  here,  as  well  as  in 
other  parts  of  the  body,  by  returning  veins. 
The  ultimate  branches  then  of  the  hepatic 
artery  terminate  in  the  hepatic  veins,  and 
thefe  return  the  blood  into  the  vena  cava 
inferior,  by  three  or  four  venous  trunks. 
Such  is  the  circulation  through  the  liver  as 
connected  with  its  nourifhment.  We  are 
next  to  confider  it  as  an  organ  of  fecretion. 

9.  THIS  organ  differs  from  every  other 
gland  of  the  body  with  regard  to  the  na- 
ture of  the  blood  from  which  fecretion  is 
performed.  While  other  fluids  are  fecreted 
from  florid  arterial  blood,  which  has  lately 
received  changes  from  the  air  by  the  inter- 
vention of  the  lungs,  the  bile  is  formed  from 
c  2 


[     '6     ] 

blood  of  a  dark  colour,  poflefling  the  com- 
mon characters  of  venous  blood,  and  is  con- 
veyed to  the  liver  by  a  vein. 

10.  THE -vena  partarum,  which  conveys 
this  Jslood,  takes  its  name  from  the  part  of 
the  liver  at  which  it  enters  ;  there  being  two 
eminences,  one  on  each  fide  of  the  fiffure, 
called  the  port^,  t where  this  veflel-  begins 
to  penetrate.  To  nnderftand  the  origin  of 
the  vena  portarum,  and  the  properties  of  the 
bloocl  which  it  conveys,  it  will  be  neceflary 
to  explain  the  circulation  through  the  chy- 
lopoietic  organs.  The  branches  of  the  cceliac 
and  mefenteric  arteries,  as  we  have  before 
obferved,  di (tribute  their  contents  to  the 
ftomach,  inteftines,  pancreas,  and  fpleen, 
"belkles  the  hepatic  artery  which  fnpplies  the 
liver.  The  blood  circulating  through  all 
thefe  vifcera,  except  the  lad,  being  returned 
by  their  refpec"Hve  veins,  is  poured  into 
their  common  trunk,  the  vena  portarum  : 
thus  the  origin  of  the  vena  portarum  ap- 
pears to  confiil  in  the  concurrence  of  all  the 


[     '7     1 

veins  of  the  peritoneal   vifcera  except   the 
liver. 

11.  As  the  function  cf  this  vein  differs 
from  that  of  other  organs,   it  has  been  fup- 
pofed  to  pofTefs  forne  peculiarities  of  flruc- 
ture. — Some  have  thought  it  more  mufcular 
than  other  veins,    and    that   its   charafters 
approach  nearer  to  thofe  of  an    artery.     It 
certainly  does  not  pofTefe  the  grand  difcri- 
minating  mark  of  an  artery,   or  the  power 
of  preferving  its  orifice  circular  when   di- 
vided tranfverfely.     If  it  differs  from  veins 
in  general,    it  is   in   having  thicker  tunics 
in  proportion  to  the  capacity  of  its  canal  ; 
but  with  refpect  to  the   arrangement   and 
difpofition  of  its  mufcular  fibres,  this  part  of 
its  ftructure  does  not  appear  fu fHci en tly defin- 
ed to  authorize  us  to  fpeak  with  precifion. 

12.  GLISSON,  whofe  opinion  ..on  this  fub- 
ject  is  not  always  quoted  with  approbation, 
conceived  its  grand  character! Hie  to  confift 
in  a  continuation  of  that  duplicature  of  the 

c  3 


[    is-  ] 

peritoneum  furrounding  the  vellels  going 
to  the  liver,  in  the  manner  of  a  capfula, 
and  to  which  it  is  ufual  to  annex  his  name. 
He  conceived,  likewife,  that  it  not  only 
envelopes  the  trunk  of  tjiis  vein,  but  ac- 
companies it  in  all  its  ramifications  through 
the  liver  5  fo  that  if  a  feclion  were  made 
into  this  organ,  the  branches  of  the  vena 
porcarum  would  be  diflinguilhed  from  thofe 
of  other  vefiels  by  the  prefence  of  this 
adventitious  tunic. 

13.  FOR  this  membrane,  which  the  ima- 
gination had  formed,  fancy  foon  fuggefted 
a  ufe — Miftaken  obfervation  had  led  him 
to  believe  that  it  pofTe fifed  mufcular  pro- 
perties, and  that  it  propelled  with  force  the 
blood,  whofe  motion  would  orherwife  have 
been  languid.  The  invefligations  of  other 
anatomifts  have  not  confirmed  this  opinion. 
They  have  difproved  the  continuation  of 
this  peritoneal  capfula  beyond  the  trunk  of 
the  vena  portarnm,  and  have  demonftrated 
that  it  does  not  envelop  the  vena  portarum 


[     19     I 

in  a  particular  manner.,  but  only  inverts  it 
in  common  \vith  other  veffels,  and  as  foori 
as  it  has  arrived  at  the  liver  it  quits  them 
altogether,  and,  by  expanding  itfelf  over 
the  fubflance  of  this  gland,  forms  its  tunic. 

14.  THE  vena  portarum  having  reached 
the  liver  at  that  part  called  the  great  fifTure, 
forms  one  large  trunk  called  the  finus  of  the 
vena  portarum,   from  which  three  principal 
branches  ulually  take  their  origin  •>  thefe,  by 
forming  fubordinate  ramifications  in  a  reori- 

o  o 

lar  feries,  at _  length  arrive  at  their  termina- 
tions. 

15.  The  extremities  of  thefe  vefiels   end 
in  two  ways  :   one  with  refpect   to   the  cir- 
culation of  the  blood  -,    the  other,    as.con- 
nected  with  their  ceconomy,     as  fecreting 
veflels.     In  the  firft  point  of  view  they   in- 
ofculate  with  branches  of  hepatic  veins,  and 
through   that   channel  return  to  the  inferior 
cava  all  that  blood  which   is  not  employed 
in  the  bufmefs  of  fecretion.      So  that  the 
hepatic  veins  are  the  common  recipients  of 


[      20      ] 

the  contents  of  the  hepatic  arteiy,  and  like- 
\vife  thofe  of  the  vena  portarum. 

1 6.  THE    fecreting    termination    of   this 
vein  is   in    the   beginnings   of  the   hepatic 
ducts,    called  pori  biliarii;    which  in   their 
origin  muft  neceiTarily  be  very  minute,  inaf- 
much  as  they  preclude  admiffion  of  the  red 
particles  of  the  blood  :    from   thefe  minute 
beginnings    they    gradually  enlarge    by    an 
linionof  branches,  until  at  length  they  pafs 
out  from   the  liver  at  its  fiiTure,    by  two  or 
three  trunks,  which  foon  after  join  together, 
and  form  the  trunk  of  the  hepatic  duel. 

17.  THE  ftructure  of  this  veiTel  is   appa- 
rently membranous,  having  no  fibres  which 
can  be  conud?red  as  mufcular,  at  leafl  as  far 
as  we  can  decide  by  ocular  demon  ftration. 
But,   as  the  eye,  even  when  aided  by  glafTes, 
is  not  always  competent  to  detect  mvifculari- 
ty,   we  are  compelled  to-  have  recourie  to 
another  and  lefs  fallacious  ted,  which  is  the 
power  of  contraction  on  the  application  of  a 
ftimulus,     Mechanical  and  chymical  ftimuli 


[       21       ] 

have  been  applied  to  this  du6l  in  a  living 
animal,  without  producing  any  contraction 
which  can  be  referred  to  mufcularity.  Some 
chymical  ftimuli,  it  is  true,  will  corrugate 
this  canal  ;  but  they  are  luch  as  produce 
effects  only  by  corrofion,  and  which  they  do 
as  readily  on  inanimate  as  on  living  matter. 

1 8.  A  MOTHER  argument  againft  their  muf- 
cularity   is,    that  canals  obvioufly  mufcular, 
readily  adapt  their  capacity  to  their  contents. 
This  lav/  is  very  evident  in  the  vafcular  fyf- 
tem.     But  when  a  biliary  duel:  has.  been  di- 
lated by  the  pafiage  of  a  gall  ilone,    it  does 
not  very  foon  return  to  its  primitive  dimen- 
fions.     And,   perhaps,  thofe  painful  affecti- 
ons of  thefe  parts,   which   have    been    very 
commonly   confide  red  fpafmodic,    may  find 
a  more  adequate  explanation  in  the  pafiage 
of  a  calculus. 

19.  IF  the  internal  furface  of  this  fyftem 
of  veffels  be  examined,  in  will  be  found  mo- 
derately vafcular,   as  there  is  an   appearance 
of  follicles  in  many  parts  -,   hence  it  is  proba- 
ble,   that  it  fecretes  a  mucous  kind  of  fluid. 


[      22      ] 

20.  BESIDES  the  veflels  already  defcribed, 
the  liver  is  very  plentifully  ftipplied  with 
abforbents,  which  take  their  origin  from 
every  part  of  itsfubftance,  but  more  efpeci- 
allyfrom  the  branches  of  the  hepatic  duel". 
The  proof  of  this  origin  will  be  referved 
until  we  treat  of  the  ceconomy  of  this  organ. 
From  the  interior  part,  the  abforbents  pur- 
fue  the  direction  of  the  furface,  fpme  rami- 
fying on  the  anterior  and  fome  on  the  pof- 
terior  furface :  their  difpolkion  while  on 
thefe  parts  is  arborefcent.  Thofe  on  the  con- 
vex^ furface  incline  towards  the  direction  of 
the  falciform  ligament  upon  which  they  pafs, 
and  extending  their  courfe  in  the  direction 
of  the  diaphragm,  terminate  in  the  thoracic 
duct  near  to  that  part.  Thofe  which  ramify 
on  the  concave  furface,  form,  by  a  feries  of 
junctions,  a  common  trunk,  which,  pafs- 
ing  from  the  liver  in  the  direction  of  the 
hepatic  artery,  and  with  it  and  the  other 
vefTels  being  inclofed  in  Gliflbn's  capfula, 
terminate  in  the  thoracic  duct  near  the 
receptaculum  chyli. 


21.  THESE    two    fets  of    abforbents, 
while   ramifying  within    the  liver,    have  a 
free    communication  with   each    other,     as 
may  be  proved  by  injection  with  mercury. 
From  a  fuperficial  abforbent  on  the  convex 
furface,  mercury  will  fometimes   penetrate 
the  fubftance,    and  thence  pervade  thofe  on 
the  concave  fide,    from  which  the  thoracic 
duel  may  be  filled. 

22.  THESE  veffels  poflefs  the  fame  cha- 
racter while    in  this  organ   as    they   do    in 
other   parts  of  the  body ;    that   is  to  fay, 
they   are  valvular.        But    notwithftanding 
this,    they  may  be  injected  'in  a   direction 
contrary   to    that    in   which   their  contents 
move.      This,    though  apparently   a   para- 
dox,   is    ftrictly    confonant   to  reafon    and 
fact;    for  the  function    of  the  valves    here 
is  lefs  complete   than  in  fome  other  parts 
of  this  fyftem,  fo  that  bypreffure,    mercury 
may  take  a  retrograde  courfe  in   the  fame 

vefTel. Another   reafon   is,    that   as   the 

lateral  .communicating   veflels   exceed   the 


[       24      ] 

valves  in  number,  aclufter  of  abforbents  may 
be  injecled  by  a  conrfe  in  part  retro- 
grade, and  in  part  circuitous.  It  is  in  this 
way  an  injection  may  be  made  to  pafs 
through  the  branches  of  the  fpermatic  vein, 
in  a  direction  contrary  to  the  natural  circu- 
lation -,  yet  thofe  vetfels  are  plentifully  fur- 
niflied  with  valves. 

23.  BESIDES  vefifels,  the  liver  is  furniflied 
with    nerves,    though   not   very  plentifully. 
The  par  vagumand  intercoftal  nerves,  while 
in  the  cavity  of  the  thorax,  communicate  by 
branches    with   each   other.     Near    to  this 
part  of  junction  feveral    branches   are   fent 
off,    fomeof  which  are    diftributed  to  parts 
contiguous,  others  to  more  diftant  organs. 
But  there  is  detached  from  each  fide  a  branch 
more  confpicuous  than  the  others,  viz.    the 
fplanchnic    nerves,   both    of  which,  having 
pierced  the  diaphragm,  unite. 

24.  AT  the  part  of  union  there  is  formed 
a  ganglion,  which,   from  its  crefcent-like 


Figure,  is  called  femilunar.  From  this  gan- 
glion a  multiplicity  of  nervous  filaments  are 
parting  off  in  various  directions,  which,  in- 
termixing and  obferving  a  radiated  courfe, 
form  the  folar  plexus.  From  this,  feveral 
fubordinate  plexufes  are  detached,  which  re- 
ceive names  from  the  parts  they  fupply; 
hence  the  names  of  ftomachic  plexus,  fplenic 
plexus,  &c. — But  from  its  right  portion, 
Feveral  fmall  nervous  filaments  pafs,  which, 
furrounding  the  hepatic  artery,  accompa- 
ny it  to  the  liver,  and  take  the  name  of 
hepatic  plexus. 


valves  in  number,  aclufter  of  abforbents  may 
be  injected  by  a  courfe  in  part  retro- 
grade, and  in  part  circuitous.  It  is  in  this 
way  an  injection  may  be  made  to  pafs 
through  the  branches  of  the  fpermatic  vein, 
in  a  direction  contrary  to  the  natural  circu- 
lation j  yet  thofe  vetfels  are  plentifully  fur- 
niilied  with  valves. 

23.  BESIDES  veiTels,  the  liver  is  furnifhed 
with   nerves,    though   not   very  plentifully. 
The  par  vagumand  intercoftal  aerves,  while 
in  the  cavity  of  the  thorax,  communicate  by 
branches    with   each   other.     Near    to  this 
part  of  junction  feveral    branches   are   fent 
off,    fomeof  which  are   diftributed  to  parts 
contiguous,  others  to  more  diflant  organs. 
But  there  is  detached  from  each  fide  a  branch 
more  confpicuous  than  the  others,  viz.    the 
fplatichnic   nerves,  both   of  which,  having 
pierced  the  diaphragm,  unite. 

24.  AT  the  part  of  union  there  is  formed 
a  ganglion,  which,   from  its  crefcent-like 


figure,  is  called  femilunar.  From  this  gan- 
glkm  a  multiplicity  of  nervous  filaments  are 
pafling  off  in  various  directions,  "which,  in- 
termixing and  obferving  a  radiated  courfe, 
form  the  folar  plexus.  From  this,  feveral 
fubordinate  plexufes  are  detached,  which  re- 
ceive names  from  the  parts  they  fupply; 
hence  the  names  of  ftomachic  plexus,  fplenic 
plexus,  &c. — But  from  its  right  portion, 
feveral  fmall  nervous  filaments  pafs,  which, 
furrounding  the  hepatic  artery,  accompa- 
ny it  to  the  liver,  and  take  the  name  of 
hepatic  plexus. 


CHAP.    III. 


THE  NATURE  OF  THE  BLOOD 

CIRCULATING  THROUGH  THE  VENA 

PORTARUM  CONSIDERED. 


SECT.  I. 

G  given  a  general  defcription  of 
the  veflels  fupplying  the  liver,  we  are  led  to 
examine  into  the  nature  of  their  contents. 
And  here  we  may  remark,  that  it  is  very  de- 
firable,  but  at  the  fame  time  extremely  dif- 
ficult, to  afcertain  the  peculiar  chara6ters 
of  the  blood,  after  circulating  through 
each  of  the  chylopoietic  vifcera,  previoufly 
D  2 


I     28    ] 

to  its  paflage  into  the  liver,  by  the  vena 
portarum  j  and  to  determine  why  it  feems 
better  adapted  to  the  fccretion  of  bile  than 
common  arterial  blood,  from  which  other 
fecretions  are  fupplkd. 

2.  THAT  venous  blood  is  more  favorable 
to  tliis  fecretion  than  arterial,  is  very  evi- 
'  dent ;  this  exception  of  the  liver  to  Nature's 
law,  in  the  ceconomy  of  other  glands,  may 
be  admitted  as  a  proof.  But  the  peculiar 
changes  induced  in  the  blood,  after  circu- 
lating through  the  arteries  of  the  flomach> 
and  yielding  the  gaftric  fluid  j  after  penetra- 
ting the  pancreas,  and  there  affording  pan- 
creatic juice  ;  after  pervading  the  inteilines> 
where  it  not  only  gives  out  the  inteftinal 
mucus,  but  from  its  vicinity  to  feculent 
matter  may  receive  putrefcent  properties, 
are  at  prefent,  and  may  perhaps  continue 
long  to  afford,  an  ample  field  of  fpeculation 
and  conjecture. 

3.  THE  power  of  thefpleen  in  thisrefpecl: 
has  been  particularly  acknowledged  and  in- 


[     29     ] 

'  Med  upon 5  infomuch  that  modern  phyfiolo- 
^ifls  have  confid^red  this  as  its  only  function. 
That  the  fpleen,  in  common  with  the  other 
vifcera,  may  contribute  fomevvhat  to  change 
the  properties  of  the  circulating  blood, 
ought  not  to  be  denied;  but  whether  this  be 
the  principal  and  only  end  of  its  function,  I 
think,  cannot  be  too  carefully  invefligated. 

4.  THE  number  and  rank  of  thofe  phy- 
fiologifts,  who  have  confidered  the  fpleen 
as  an  auxiliary  organ  to  the  liver,  are  too  re~ 
fpectable  to  be  oppofed  on  any  ground,  ex- 
cept that  of  experiment  and  induction. 

When  opinion  is  oppofed  to  opinion,  and 
no  reafons  adduced  on  either  fide  in  fupport 
of  each,  whatever  difference  there  may  hap- 
pen to  be  in  the  credit  or  authority  of  their 
refpective  promulgators,  the  opinions  thern- 
felves  ftand  on  equal  ground.  It  is  the  rea- 
fons then  which  ftamp  the  true  vak-e  of  any 
opinion,  and  to  them  only  we  (hall  clirecl 
our  inveftigation. 


[      32      ] 

iment  by  way  of  refutation.  But  waving 
that  controveriy,  let  us  inquire  how  far  the 
fpleen  afting  on  its  blood  as  a  diluting  or- 
gan, can  be  fupported  by  facts. 


EXPERIMENT. 

10.     THE  abdomen  of  a  living  dog  being 
opened,   and  the  fpleen  with  its  veiTels  being 
drawn  gently   out,  blood  was  taken   both 
from  the  artery  and  the  vein,    and  received   « 
into  cups  of  fimilar  fhape  and  equal    fize. 
On  weighing   each,  there  was  found  to   be 
420  grains  of  arterial,   and  468  of  venous 
blood.     Both  coagulated  in  lefs   than   two 
minutes,    and  in  about  the  ufual  time  they 
feparated  into  Jerum  and   craffamentum.     In 
twenty-four  hours   the  Jerum  of  both  was 
accurately     weighed :    the    420   grains    of 
blood  from  the  fplenic  artery  feparated  191 


C    33    3    - 

grams  of  ferum ;  the  468  grains  from  the 
vein,  feparated  213  grains. 

ii.  BUT  our  conceptions  of  this  matter 
•will  be  much  aflifted  by  inftituting  a  com- 
parifon  with  one  common  ftandard,  ftill 
preferving  the  ratio. 

Therefore  we  fay,  1000  parts  of  blood 
from  the  fplenic  artery  feparated  454,  while 
the  fame  quantity  from  the  vein  yielded  455  : 
a  difference  fo  inconfiderable  as  this,  furely 
can  never  be  laid  hold  of  as  a  proof  that  the 
fpleen  is  fubfervient  to  the  liver,  on  the 
principle  of  a  diluting  organ. 

But  to  purfue  the  inquiry  ftill  further,  I 
thought  it  of  importance  to  examine  the 
fluidity  of  ihe/erum. 


EXPERIMENT. 

12.     EQUAL     portions     of    each   Jerum 
were  expofed  nearly  to  the  fame  degree  of 


[     34    ] 

heat,  until  coagulation  had  taken  place. 
Upon  prefling  the  furface  of  each,  there 
exuded  at  different  points  fmall  particles  of 
a  watery  fluid,  which  Senac  calls  the  ferofity 
of  the  blood;  and,  upon  examining  the 
proportions  of  each,  I  could  not  difcover 
any  difference.  Therefore,  if  we  admit  that 
the  liver  receives  any  affiftance  from  the 
fpleen,  it  does  not  appear  to  owe  any  thing 
to  that  organ  on  the  principle  of  dilution. 

13.  THE  other  change  fuppofed  to  bfe 
induced  in  the  blood  by  its  circulation 
through  the  fpleen,  is  a  putrefcent  tenden- 
cy :  this  has  been  conjectured  in  part  from 
its  contiguity  to  the  colon,  and  in  part  from 
the  languid  (late  of  the  circulation  through 
that  vijcus. 

Without  instituting  any  ferious  inquiries 
into  the  probable  weight  of  thefe  reafons, 
and  their  fufficiency  to  fupport  the  propofi- 
tion,  let  us  inquire  into  the  facl:  itfelf. 


[     35     1 


EXPERIMENT. 

14.  Two  portions  of  blood,  one  taken 
from  the  fplenic  artery,  the  other  from   the 
vein,  were  expofed  for  four  hours  to  a  heat 
upwards    of   90  degrees  -,    but   neither   of 
them  betrayed  the  fmalleft  marks  of  putref- 
cency. 

This  opinion  appears  to  have  originated 
in  an  erroneous  idea  concerning  the  proper- 
ties of  the  bile,  which  fome  have  confidered 
as  the  mod  putrefcent  fluid  of  the  body  ; 
but  with  extreme  impropriety,  as  experi- 
ments have  fully  evinced. 

15.  THUS  far  our  inquiries  have  favour- 
ed very  little  the   connection  between   the 
fpleen  and  the  liver.     But  in  order  that  the 
refutation  may  be  more  complete,  it  is  ne- 
cefTary  that  a  comparifon  be  made  between 
bile  taken  from  an  animal  whofe  fpleen  has 
been  previouffy  removed,  and  one  in  which 

is  ilill  remaining. 


EXPERIMENT. 

16.  THE  fpleen  of  a  dog  was   removed, 
and  the  wound  healed  up  in  a  few  days.     He 
was  kept  feveral  weeks  afterwards,    during 
which  time  he  ran  about  the  houfe  like  any 
other  dog.     Another  dog  in  perfect    health 
being  procured,  both  were  flrangled,    and 
the  bile  contained  in  the  ^all  bladder  of 
each  collected  in  feparate  veflels  for  the  pur- 
pofe  of  comparifon. 

17.  THE     colour   of  both,    which  was 
that  of  a    bottle-green,  correfponded  very 
exadry. 

There  was  no  difference  in  tenacity  :  in 
both  it  was  juft  fufficient  to  prevent  its  fall- 
ing from  a  phial  in  drops. 

The  tafte  of  each  was  intenftly  bitter, 
and  (lightly  pungent. 

No  perceivable  difference  in  frnelL 

Portions  of  each  being  mixed  with  litmus. 


*[     37     j 

lurmerick,  and  fyrup  of  violets,  betrayed 
no  difference  of  colour. 

Equal  portions  of  each  of  thefe  fpecimens 
of  bile,  being  mixed  with  equal  portions  of 
concentrated  vitriolic  acid,  a  brown  colour 
was  produced  ;  and  with  a  very  diluted  vi- 
triolic acid,  a  draw  colour. 

With  concentrated  nitrous  acid,  both  ef- 
fervefced,  and  exhibited  a  brown  colour. 

With  alkohol  there  was  a  flocculent  ap- 
pearance. Evaporation  to  a  thick  extract 
left  a  refiduum,  which  was  highly  inflammable. 

1 8.  THE    refult   of  thefe    experiments 
makes  it  highly  probable,   that  the  bile  fe- 
creted  after  the  lofs  of  the  fpleen,  differs  in 
no  refpect  from  other  bile ;  and  that  the  li- 
ver in  theexercife  of  its  function  is  perfectly 
independent  on  that  vifcus. 

19.  TH  us  we  fee  that  an  opinidn,  which 
has  received  a  degree  of  currency  from  the 
fandion  of  .men  of  eminence,   lofes  its  im- 
portance, when  examined  by  the  teft  of  ex- 


[     38     ]. 

periment  j    and  a    patient  inveftigation  of 
"Nature's .operation,  on  this  plan,  mufl  ever 
prevail  over  authority  or  prejudice. 

20.  IT  has  been  proved  above,  that 
/venous  blood  is  the  proper  fource  of  the 
biliary  fecretion.  Some.  afTert,  that  fome 
additional  properties  are  imparted  to  it 
during  its  circulation  through  the  peritonaea! 
<vijcera  :  but  neither  experiment  nor  obferva- 
tion  has  contributed  any  thing  conclufive 
in  favour  of  fuch  opinion. 

ai.  THE  peculiar  ceconomy  of  the  bi- 
liary organ  in  the/^to,  is  particularly  de- 
fervingour  confideration,  as  the  blood  from 
which  the  fecreted  fluid  is  made,  cannot  be 
jconfidered  as  ftrictly  venous,  but  as  partak- 
ing, in  fome  meafure,  of  the  arterial  cha- 
racter ;  and  this  intermediate  condition  of 
blood  appears  to  produce  a  correfpondent 
ftate  of  the  bile :  for  it  is  matter  of  noto- 
riety that  foetal  bile  is  lefs  active  and  con- 
centrated, and  abounds  more  in  the  watery 
principle,  than  that  of  the  adult.  This 


[     39     ] 

being  granted,  it  neceflarily  follows,  that 
whatever  changes  are  induced  in  the  blood 
in  paffing  from  the  arterial  to  the  venous 
condition,  thofe  changes  furnifh  the  prin- 
ciples which  adapt  the  blood  more  com- 
pletely to  this  purpofe.  But  as  phyfiologills 
are  not  agreed  refpe&ing  the  efTential  dif- 
ference between  arterial  and  venous  blood, 
whatever  properties  the  one  poflefTes  of* 
which  the  other  is  cleft  itute,  any  reafoning 
founded  on  fuch  an  uncertain  bafis  mufl 
necefiarily  be  unmeaning  and  inconclufive. 

22*  BUT  to  revert  to  the  ceconomy  of  the 
liver  in  thefatius'i  it  may  be  obferved,  that 
befides  the  blood  which  is  lent  to  it  by  the 
hepatic  artery  and  vena  por/arum,  it  receives 
a  large  portion  by  the  umbilical  vein. 

23.  To  understand  this,  we  fhould  advert- 
to  fome  of  the  peculiarities  of  thefatus  in 
utero.  It  is  very  generally  admitted,  that 
the  placenta  is  to  thefatus,  what  the  lungs 
are  after  birth  -,  that  by  both  a  change  is 

induced  in   the  blood,    by  which  it   lofes 
E  2 


C     40     ] 

the  venous  character,  and  afTumes  the  arte- 
rial one,  in  fuch  proportion  as  the  exigen- 
cies of  each  may  require.  As  foon  as  the 
change  is  wrought  in  the  blood  of  the  pla- 
centa, it  is  conveyed  by  the  umbilical  vein 
to  the  liver  of  thefatus  ;  part  of  this  blood 
mixes  with  the  common  blood  of  the  vena 
portarum,  and  with  it  concurs  in.furnifhing 
the  fecretion  of  the  bile ;  the  remainder  is 
carried  into  the  vena  cava  inferior  by  the 
canalis  venofus. 

24.  Ixthef&tuS)  then,  it  feems  that  the 
blood  in  the  vena  port  arum  has  more  of 
the  arterial  condition  than  that  of  the 
adult,  and  feems  to  produce  a  bile  of  lefs 
activity. 


CHAP.    IV. 


ON  THE  HEPATIC  ARTERY, 

AND  THE  OFFICE  OF  THE  BLOOD 

WHICH  IT  CONTAINS. 


SECT.     I. 

JDy  far  the  greater  number  of  phyfioio- 
gifts  have  agreed,  that  the  hepatic  artery 
carries  blood  to  the  liver  for  its  nourifh- 
ment,  and  that  this  is  its  only  deflination. 
There  are  a  few,  however,  who  incline  to 
a  different  opinion  -,  and  contend  that,  in 
addition  to  this  function,  it  concurs  with 
the  vena  fortarum  in  the  fecretion  of  the 
bile. 


[     42     ] 

2.  THE  reafons  on  which  this  latter  opi- 
nion  is   founded,  have  at  lead  fpecioufriefs 
to  recommend  them  ;  and  in  our   inquiry 
into  this  queflion,  the  merits  of  both  opi- 
nions will  be  carefully  inveftigated  :   and  at 
the  fame  time  that  we  efteem  it  our  duty  to 
detect  and  expofe   fallacy   wherever  it  ap- 
pears, it  is  no  lefs  congenial  to  our  inclina- 
tion to  afcribe  to  each  argument  its  due  and 
proper  force. 

3.  THE  firft  pofition  advanced  in  favour  of 
this  opinion  is,    "That  it  is  probable  that 
cc  the  office  of  the  hepatic  artery  is  not  con- 
cf  fined  to|jhe  nourifhment  of  the  liver,  from 
<c  the  difproportion  of  its  veflels  to  the  bron- 
<c  chial  arteries,  which  nourifh  the  lungs." 

4.  IN  examining  this  argument,  we  find 
it  is  of  an  analogical    nature  ;   and  confe- 
quently,  if  well  founded,  cannot  extend  its 
force   beyond   preemption  or  probability. 
But  we  muft  always  keep  in  view  the  differ- 
ence between  an  analogy  which  is  clofe,  and 
where  the  points  of  coincidence  are  ftrik- 


[    43    1 

ing  and  well  marked  ;  and  one  where  they 
are  but  few,  and  thofe  not  very  evident. 
Even  the  former  will  always  fall  fhort  of 
proof,  while  the  latter  can  fcarcely  warrant 
ib  much  as  a  conjecture. 

Therefore   the   object  which  is  held  out 

as  the  analogy  cannot  be  "too  feverely  fcru- 

• 
tinized. 

5.  THIS  argument,  then,  refts  on  a  pre- 
fumption,  that  the  lungs,  which  are  at  leaft 
as  marly  as  the  liver,  are  nourifhed  by  the 
bronchial  arteries,  which  are  much  lefs  ca- 
pacious than   the  hepatic  artery  ;   therefore 
it  has  been  faid,  if  the  bronchial  arteries  are 
fufficient  to  nourifh  the  lungs,  the  hepatic 
artery  ought  to   do  fomething   more  than 
nourifh  the  liver  ;    or,   in  other  words,  it 
ought  to  contribute  fomewhat  to  the  fecre- 
tion  of  bile. 

6.  THE   inference  would  be  natural  and 
fair,   provided  it  were  firft  eftablifhed,  that 
the  bronchial  arteries  alone  nourifhed  the 
lungs. 


[     44    ] 

7-  BEFORE  the  days  of  Ruyfch,  phyfiolo- 
gifts  imagined  that  the  lungs  were  nourifhed 
by  the  pulmonary  artery  ;  they  were  the 
more  perfuaded  of  this,  becaufe  the  exift- 
ence  of  any  other  veflel  going  to  the  lungs 
had  not  been  fufpected.  But  Ruyfch,  «by 
by  his  art  of  injecting,  difcovered  the 
bronchial  arteries,  and  thefe  he  confidered 
as  their  true  nourifhing  veflels  ;  and  what 
feemed  to  give  flrength  and  confirmation  to 
this  opinion  was,  that  the  blood,  while  cir- 
culating through  the  pulmonary  arteries, 
porTefTes  the  venous  character,  and  of  courfe 
is  unfit  for  nutrition  ;  while  that  fent  by  the 
arteries  of  Ruyfch  is  in  every  refpect  adapted 
to  this  end. 

But  the  following  arguments  may  he  ad- 
duced, not  only  from  fpeculation,  but  from 
experiment,  to  prove  that  the  fubftance  of 
the  lungs  is  nourifhed  by  the  blood  in  the 
extreme  branches  of  the  pulmonary  artery  5 
and  that  the  bronchial  arteries  of  Ruyfch  are. 
confined  to  the  nourifhment  of  the  branches- 
of  the  bronchi*  alone* 


As  the  blood  in  the  fmaller  branches  of 
the  pulmonary  artery  is  expofed  to  the  in- 
fluence of  the  air,  it  mud  necefTarily  receive 
a  change,  and  afTume  the  arterial  character  ; 
in  which  ftate  it  is  as  fit  for  nutrition  as  the 
blood  circulating  in  other  arteries. 

We  learn  from  obfervation  and  experi- 
ment, that  when  inflammation  has  occafion- 
ed  the  furfaces  of  the  pleura  and  lungs  to 
adhere,  fuch  adhefions  become  vafcular,  and 
may  be  injected  by  the  pulmonary  artery  : 
and,  as  the  blood  diftributed  to  thefe  adhefi- 
ons is  for  the  purpofe  of  their  nourifhment, 
their  communication  with  the  ultimate 
branches  of  the  pulmonary  artery  proves 
inconteftably,  that  fuch  blood  is  fit  and 
proper  for  the  nourifhment  of  the  lungs. 

Hence  it  appears,  that  there  is  not  the 
lead  analogy  between  the  hepatic  artery  and 
the  liver  on  the  one  hand,  and  the  lungs 
and  the  bronchial  artery  on  the  other.  Con- 
fequendy  the  argument,  which  refted  on 
this  analogy,  is  not  entitled  to  notice. 


[    46     ] 

"  A  iecond   argument  in   favour  of  the 

:c  hepatic  artery  aflifting  in  the  fecretion  of 

''  bile,   is  founded  on  an  apparent  commu- 

ccnication    between  the  ultimate  branches 

cc  of  thofe  veflels  and  the  beginnings  of  the 

;c  biliary  duels ;   for,  fay  the  advocates  for 

f  this  dodrine,  afubtile  fluid  may  be  inject- 

c  ed  with  eafe  from  one  fet  of  veflels  to  the 

<c  other." 

That  the  biliary  duels  may  be -filled  by 
fubtile  fluid  injected  into  the  artery,  we 
fhali  not  deny  ;  but  this  fact  does  by  no 
means  prove  a  direct  communication  be- 
tween one  fet  of  veflels  and  the  other,  as 
will  very  foon  appear. 

When  we  reflect  on  the  circulation 
through  the  liver,  it  mud  be  evident  to  us, 
that,  as  the  hepatic  veins  return  blood  both 
from  the  hepatic  artery  and  the  vena  porta- 
rum  ;  the  hepatic  artery  has  communication 
with  the  latter  by  the  intervention  of  the 
hepatic  veins,  and  that  a  fluid  injection 
thrown  in  by  the  artery  will  pafs  very  readi- 
ly into  the  veins  3  where,  if  its  exit  be  pre- 


[    47     1 

vented  by  tying  them  up,  it  may  regurgitate 
into  the  terminations  of  the  vena  port  arum, 
and  thence  efcape  into  the  port  biliarii* 

But  left  this  explanation  fhould  be  ob- 
jedted  to  as  being  too  circuitous,  another 
offers  itfelf  much  more  direct,  and  which 
admits  of  proof  from  injection. 

Water  inje&ed  by  the  hepatic  duel  pafles 
with  freedom  into  the  hepatic  veins;  and 
again,  a  firnilar  fluid  pafles  eafily  from  the 
veins  into  the  duel: :  hence  a  fluid,  injedted 
by  the  artery,  pafles  firft  into  the  veins, 
and  afterwards  into  the  port  liliani ;  fo  that 
the  arguments  founded  on  the  phenomena 
refulting  from  injections  cannot  be  admitted 
as  proofs,  that  the  hepatic  artery  exercifes 
a  fecretory  function. 

The  capacity  of  the  hepatic  artery  with 
relation  to  the  bulk  of  the  liver,  has  been 
the  ground  on  which  its  fubferviency  to  the 
fecretion  of  the  bile  has  very  much  refted, 
from  an  idea  that  it  carried  to  the  liver  more 
blood  than  the  mere  purpofes  of  nutrition 


r  48  ] 

i 

required;  hence  it  was  imagined,  that  it 
either  co-operated  with  the  vena  fort  arum 
in  the  immediate  act  of  fecretion,  or  that 
it  feparated  from  the  blood,  circulating 
through  its  extreme  branches,  a  fluid  which 
formed  one  of  the  conftituent  parts  of  the 
bile. 

But  the  capacity  of  the  hepatic  artery 
does  not  neceflarily  fuppofe  either  one  or 
the  other  of  thefe  offices;  for  it  is  well 
known,  that  parts  of  the  body,  which,  are 
not  fecreting  organs,  are  furnifhed  with  a 
larger  proportion  of  arterial  blood  than  the 
liver:  of  this  kind  are  the  mufcles,  the 
brachial  artery  being  larger  with  refpect  to 
the  arm,  than  the  hepatic  artery  is  with 
refpecl:  to  the  liver. 

Now  mufcles,  we  know,  are  organs 
which  occafionally  perform  ftrong  and 
repeated  actions,  which,  like  other  actions 
when  long  continued,  tend  to  debilitate  and 
exhauft  the  machine;  but,  when  their 
exertions  are  moderate,  they  become  invi- 


I    49    ] 

gorated  and  enlarged,  and  the  increafe  of 
bulk  which  they  acquire  in  this  way,  is  prin- 
cipally owing  to  an  increafe  in  the  capacity 
of  their  blood  vefiels,  as  appears,  not  only 
from  the  more  florid  colour  of  thofe  mufcles, 
but  likewife,  from  comparing  the  capacities 
of  the  trunks  of  the  vefTels  with  the  mufcles 
themfelves. 

Tendons,  on  the  contrary,  though  parts 
equally  alive,  yet,  from  their  more  paflive 
condition,  require  a  fupply  of  blood  fuf- 
ficient  only  for  their  nourilhment. 

The  brain  is  an  organ  which,  with  rela- 
tion to  its  bulk,  receives  a  larger  quantity 
of  blood  than  any  other  part  of  the  body, 
yet  its  function  as  a  fecreting  organ  is  not 
obvious. 

The  inference  intended  to  be  drawn  from 
thefe  facts  is,  that  parts,  though  not  fecre- 
tory,  require  a  fupply  of  blood  in  propor- 
portion  to  the  actions  they  perform. 

Now  furely  we  cannot  hefitate  to  admit 
that  the  exertion  of  a  fecreting  organ  necef- 


farily  implies  a  confiderable  fupply  of  vital 
energy,  as  it  confifls  in  changing  the  blood 
into  a  fluid  different  in  all  its  properties  from 
the  blood  itfelf,  fo  that  it  may  affume  a  new 
mode  of  exiitence.  In  other  glands  arterial 
blood  ferves  the  double  pur-pole  of  being 
the  fabulum  of  the  fecretions,  and  of  fupply- 
ing  the  organ  with  vital  energy  fufficient  to 
effect  itspurpofe;  but  in  the  liver,  where 
the  fecretion  is  performed  from  venous 
blood,  which  is  unfit  for  furnifhing  it  with, 
vital  energy,  the  neceftlty  for  a  copious  quan- 
tity of  arterial  blood  feems  very  evident.  * 

*  An  extraordinary  cafe  of  Lufus  Nature  has 
lately  occurred  to  Mr.  Abernethy,  Teacher  of 
Anatomy  5  in  which  the  vena  portarum  had  a 
fingle  termination.  Inftead  of  conveying  its 
blood  into  the  fubftance  of  the  liver,  prior  to  its 
termination  in  the  inferior  vena  cava  by  the  in- 
tervention of  the  hepatic  veins,  the  blood  return- 
ed by  the  veins  of  the  different  chylopoietic  organs, 
was  conveyed  by  the  vena  portarum  immediately 
into  the  vena  cava  inferior  near  to  the  origin  of 
the  emulgent  veins.  The  hepatic  artery,  which 
appeared  to  be  fomewhat  enlarged,  was  the  only 
veflel  carrying  blood  to  the  liver,  and  in  thisindi. 


f s.  ]          -    . 

Admitting  the  vena  portarum  alone  to  be 
the  fecreting  vefiel,  and  that  the  hepatic 
artery  furnifhes  blood  only  for  imparting  a 
due  degree  of  energy,  it  ftill  remains  a  quef- 
tion,  of  what  nature  the  communication 
between  thefe  twoveflels  is.  Perhaps  here 
it  may  be  more  confonant  to  the  true  fpirit 
of  phyfiology  to  content  ourfelves  with  the 
the  fact,  and  to  trace  its  application  to  the 
ceconomy  of  this  organ,  than  to  indulge 
ourfelves  in  framing  vifionary  hypothefes, 
which  exiil  only  in  the  efflorefcence  of  fancy. 

vidual  inftance  it  appeared  to  perform  the  double 
function  of  nutrition  and  fecretion.  That  bile 
was  fecreted  in  this  place,  appears  evident  from 
the  prefence  of  it  both  in  the  inteftines,  and  gall 
bladder.  The  latter,  though  of  its  ufual  fize, 
contained  only  a  fmali  portion  of  this  fluid,  the 
properties  of  which  were  very  fimilar  to  thofe  of 
the  bile  in  other  young  fubjecls.  The  fubject  of 
the  prefent  cafe  was  a  child  apparently  about  one 
year  old,  in  every  refpect  well  nourished. 


[     53    3 


CHAP.     V. 


INTERIOR  STRUCTURE  OF  THE 
LIVER. 


SECT.     I. 


i 


T  is  from  the  blood  circulating  through 
the  branches  of  the  vena  portarumy  that 
bile  is  fecreted  ;  but  in  what  particular  part 
of  this  fyftem  the  change  commences,  and 
what  is  theprecifeftructureof  the  parts  adapt- 
ed to  this  end,  are  fit  fubjects  for  inquiry. 

a.  IT  has  been  already  obferved,  that  the 
ultimate  branches  of  the  vena  portarum  have 
a  double  termination  ;  one  of  which  is,  with 


[    54    ] 

refpe6t  to  the  circulation  of  red  blood,  by 
the  beginnings  of  the  hepatic  veins  ;  the 
other,  with  refpect  to  the  immediate  fecret- 
ing  vefTr Is,  by  thepori  biliariL 

3.  DOES  the   change   commence  in  the 
fmall  branches  of  the  vena  -port arum  before 
they  terminate  in  the  hepatic  veins  ? 

4.  THIS  is  fcarcely  probable  ;    for  any 
bilious   properties,   which    the    blood  may- 
have    acquired  at  this  part,  would  be  loft 
with  refpecl:  to  the  hepatic  duel,  as  it  finds 
a  more    ready  courfe  through   the  hepatic 
veins :     befides    which,      the     conftitution 
would  be  in  a    continual  ftate  of  jaundice. 

5.   THE  probability  is,  that  there  is  no 
fenfible  alteration  induced  on  the  blood  of 
the  vena  for  tar  urn  before  it  terminates  in  red 
veins.     And    as    arteries  terminate  in  veins 
by  capillary  veflels,  fo,   from  the  analogy 
which  obtains    between   the  vena  portarum 
and  an  artery,    we  prdume    that   the  fame 
termination  does  not  take  place  until   the 
branches  have  become  capillary. 


•  C    55    1 

6.  IT  follows  from  this,  that  the  true  fe- 
creting  veflels  are  the  very  ultimate  branches 
which  communicate  with  the  port  biliarii. 

7.  THE  next  qu  eft  ion  is,  how  far  the  fe- 
cretion  of  bile  is   connected  with  any  pecu- 
liar arrangement  or  ftrudhire  of  thefe  parts : 
or,  in  other  words,   whether  the   fecreting 
veflel  communicates  with  the  beginnings  of 
the  excretory  duel  by  a  cylindrical  continu- 
ation of  canal,  or  by  the  interpofition  of  a 
cell  or  follicle. 

8.  ON  this   point,  the  opinions  of  Mai- 
pighi  and  Ruyfch  divide  anatomifts  :  Malpigbi 
having  examined  into  the  (truclure  of  glan- 
dular bodies,  obferved  bundles  of  circum- 
fcribed  knotted  appearances  afTuming  a  glo- 
bular form,  to  which  he  gave  the  name  of 
corpora  globcja  \    and,   by  further  examinati- 
on,   by  means  of  injection,  he  found   them 
ftill    more   confpicuous   in   confequence  of 
diftention  :  hence  he  inferred  that  they  were 
hollow,  and  that  each  of  them  confifted  of 
a  cell  or  follicle. 


[     56    ] 

9.  RUYSCH,  it  Teems,  in  the  earlieft   part 
of  life,   embraced  this  opinion  ;    but   from 
employing  himfelf,  frequently,  in  exploring 
the  flructure  of  glandular  bodies  by    injec- 
tion, lie  was  led   to  relinquifh  the  doctrine 
of  Malpigbi,  and  to   inttitute  another  which 
feemed  to  him'  more  cohfonant  to  nature. 

10.  FROM  his  injections  he  was  induced  to 
believe,  that  the  appearances   defcribed  by 
Malp'ghi    were   fallacious;    and    that   they 
were  not  mere  crypt*,  or  cells,  as  "they  had 
been  reprefented,  but  confided  of  aferies  of 
veflcls  coiled  up  in  a  circumfcribed  form, 
and,    that  the  ultimate  branches  of  the  fe- 
creting  veffel  communicated,  both  with  the 
returning  vein  and  excretory  duel  by  a  con- 
tinuation of  canal. 

11.  WITHOUT  examining  the  merits  of 
thefe  doctrines,  as  applied  to  different  glan- 
dular bodies,   we  may  obferve,   that  in  the 
liver  there  are  fome  appearances  favourable 
to  the  Malpighian  opinion.     If  a  fubtile  in- 
jeftion  be  thrown  in  by  the  vena  portarum* 


[    57    ]       . 

and  the  liver  be  afterwards  cut  into  thin 
dices,  there  will  be  found  knotted  appear- 
ances, that  bear  a  ftrong  refemblance  to 
cells,  and  which,  from  their  equality  of  bulk, 
and  uniformity  of  fhape,  cannot  be  confi- 
dered  as  the  produce  of  extravafation. 

12.  THE  kidney  likewife,  when  injected 
by  the  emulgent  artery,  rather  minutely  ex- 
hibits, in  its  cortical  part,   knotted  appear- 
ances equally  regular  with  thofe  in  the  liver. 

13.  BUT  here  again  the  queftion  returns 
upon  us-— Do  tbey,  or  do  thsy  not*  confifl  of  of- 

Jemblages  ofveJftJs  •>  or  are  they  mere  cavities  ? 
Feeling  my  incapacity  of  folving  this  pro- 
blem to  the  fatisfadion  of  my  readers,  I  muft 
beg  leave  to  withdraw  myfelf  from  the  con- 
ted  in  the  beautiful  language  of  the  Roman 
poet : 
"  Non  noftrum  inter  vos  tantas  componere  litest 


CHAR    VI, 


COURSE  OF  THE  BILE 


SECT.   I. 

V^ONFESSING,  then,  our  inability  to  deter- 
mine the  precife  ftrudture  and  mechanifm 
of  the  parts,  which  form  the  immediate  feat 
offecretion,  it  remains  to  trace  the  courfe 
of  the  bile  from  the  interior  part  of  the  liver 
to  the  place  deftined  for  its  reception. 

2.  THE  bile  being  formed,  is  convey- 
ed from  the  feat  of  fecretion,  by  the 
branches  of  the  hepatic  dycTr,  which,  at  their 
origin,  are  very  minute,  and  are  there  called 
fort  biliarii.  From  thefe  its  pafTes  into  larg- 


[    60    ] 

cr  branches,   and  thence  gradually  into  the 
trunk  of  the  hepatic  duct. 

3.  IT  is  probable  that  the  bile  is  not  mere- 
ly conveyed  through  thefe  pafTages,  but  that 
it  undergoes,  during  this  courfe,  a  change 
from  dilution  to  concentration  ;   for  the  nu- 
merous abforbents  with  which  the  liver  is 
fupplied,    and  which  originate  from  its  inte- 
rior parts,  make  it  highly  probable  that  the 
more  aqueous  particles  are  removed  by  that 
fyftem,    and  carried   into    the    circulation, 
leaving  the  remaining  fluid  in  a  more  con- 
centrated ftate. 

4.  THE  bile,  having  arrived  at  the  trunk 
of  the  hepatic  duct,  naturally  pafles  forwards 
into  the  duodenum.     But  we  are  not  to  con- 
fider  its  motion  as  uniformly  progreffive,  and 
without   interruption;   for   it  is    probable, 
from  the  oblique  manner  in  which  the  biliary 
duel  perforates  the  fubftance  of  the  intefline, 
that  the  perifcaltic  motion  of  that  gut,  con- 
fiding in  part  of  the  contraction  of  its  circu- 


[    6i     ] 

lar,  and  in  part  of  that  of  its  longitudinal 
fibres,  will,  by  comprefling  the  duct  at  its 
termination,  occafion  frequent,  but  momen- 
tary, interruptions. 

5.  DURING  thefe  periods   the  duct   mud 
necefTarily  fuffer  a  degree  of  diftention,   but 
which  is  foon  relieved  by  means   of  a  canal 
of  communication  with  the  gall  bladder,  viz. 
the  cyftic  duel.      So  that  it  appears,    that 
the  motion  of  the   bile  is  not  conftantly  in 
the   fame   direction,    but  fometimes  paffing 
from  the  liver  to  the  inteftine,    at  others, 
from  the  inteftine  to  the  gall  bladder. 

6.  IN   moft  fubjects   that  we    examine, 
this  receptacle  contains  aconfiderable  quan- 
tity of  bile ;  on  an  average,   an  ounce  may 
be  about  the  quantity. 

7.  IF  this  bile  be  compared  with  that  of 
the  hepatic  duct,  it  will  be  found  thicker  in 
its  confidence,  of  a  darker  colour,  and  more 
pungently  bitter:  for  here  alfo,  as  well  as  in 
the   liver,    there  are  numerous  abforbents, 
which  remove  the  watery  parts.     But,  it  is 

G 


[    62    ] 

probable,  that  the  increafed  vifcidity  de- 
pends in  part  on  the  mucus  fecreted  by  the 
gall  bladder  itfelf,  fo  that  cyflic  bile  may  be 
confidered  as  a  compound  fluid. 

8.  THE  gall  bladder  then,  appears  to  be  an 
occafional  receptacle  for  the  bile,    whenever 
there  is  an  impediment  to    its  pafTage  by 
the  common  duel:  into  the   inteftine;    and 
this,  as  a  diverticulum,  prevents  a  furcharge, 
which  would   probably   take   place   in  the 
hepatic  du6t. 

9.  THAT    this   purpofe  is  anfwere'd,    is 
probable  from  what  takes  place,  when,  from 
any  caufe,  the  cyftic  dud  is  obftru&ed,  for, 
in  this  cafe,   the  bile,    finding  no  pafTage 
into  that  receptacle   when   its   courfe   into 
the  duodenum    is  obftructed,    neceflarily  ac- 
cumulates in  the  duftus  choledochus  communis 
and^  hepaticus,  and,  confequently,   enlarges 
the  capacity  of  thofe  canals. 

10.  FOP.  a  proof  that  this  is  a  law  of  Na- 
ture, we  appeal  to  the  difiection  of  morbid 
bodies  where  this  complaint  exifted  ;    and 


there  is  a   cafe   in   point,    related  by  Dr. 
Ludwig,    of  Leipfic,    in  which  the   duftus 

choledochus   communis   was    dilated    to   more 

• 

than  an  inch  in  diameter. 

11.  THIS  explanation  of  the    courfe   of 
the  bile  to  and  from  the  gall  bladder  appears 
the    moft    fatisfactory,     and  is    that    moft 
ufually  received  ;    but  the  eflablifhment  of  it 
has  met  with  oppoficion  upon  two  grounds. 

Firft,  That  the  gall  bladder  fecretes  its' 
own  bile  j  and, 

Secondly,  That  the  branches  of  the 
hepatic  duel:,  while  in  the  fubftance  of  the 
liver,  detach  fmall  canals  leading  imme- 
diately into  the  cyft;  and  from  which  they 
have  received  the  compound  name  of  hepa- 
tico-cyftic  ducts. 

12.  THE  principal  fupporter  of  the  for- 
mer of  thefe  propofitions  is  Allinus.      He 
was  led  to  this  from  the  vafcularity  of  the 
gall  bladder ;  from  its  internal  furface  hav- 
ing an  appearance  like  follicles ;    and  from 

the  gall  bladder  having  been  found  diftended 
G  ^ 


[     64    ] 

with  bile,  when  the  cyftic  duel  was  com- 
pletely obftruc~led  by  a  gall  (lone. 

The  two  firft  arguments  are  barely«pre- 
fumptive ;  it  will  therefore  be  unnecefTary 
to  refute  them  in  form. 

The  laft,  being  more  fpecious,  may  de- 
ferve  fome  confideration :  we  will  begin 
with  admitting  the  faft. 

13.  Now  it  is  well  known  that  the  gall 
bladder  frequently  contains  biliary  calculi, 
at  the  fame  time  that  it  is  diftended  with 
bile.  Suppofing,  then,  that  one  of  thefe 
concretions  happens  to  make,  its  way  into 
the  cyftic  duel,  and  that  the  patient,  being 
of  an  irritable  habit,  dies  from  this,  or 
from  any  other  caufe,  and  the  body  be  ex- 
amined under  thefe  circumflances  -3  in  fuch  a 
cafe  the  gall  bladder  will  be  found  diftend- 
ed  with  bile,  when  its  retrograde  courfe  by 
the  cyftic  duel  is  obftrucled  :  but  diftention 
is  from  the  bile  previoufly  contained  in  that 
receptacle. 

Here  then  is  a  fource  of  fallacy. 


14.  BUT  if  it  be  true  that  the  gall  blad- 
der is  fometimes  diftended  with  bile,  when 
the  cyftic  duct  is  obftructed,  it  is  no  lefs  fo, 
that  it  is  fometimes  found  empty,   and  fome- 
times  containing  a  fluid,    compofed  princi- 
pally of  its  mucus,  tinged  with  a  fmall  quan- 
tity of  bile. 

15.  THE  propofition   relative  to  the  ex- 
iftence  of  the  hepatico-cyftic   duels   needs 
further  fupport :   they  have  been  frequently 
fought  for,   in  vain,    in  man  and   in   other 
animals.     In  the  ox  fome  have  contended 
for  their   exiftence.      In  the  ferpent  tribe 
they  certainly  do  not   exift;    for   in    thefe 
animals,   the  gall  bladder  is  detached  from 
the  liver,  fo    that   there  is  no  poffibility  of 
communication  except  by  the   intervention 
of  the  cyftic  duct.     In   the   human  fubjedt 
their  exiftence  may  be  eafily  diiproved  by 
experiment. 

16.    IF  the  gall  bladder  be  emptied  of  its 
contents,    and  either  air  or  water  be  injeft-? 

c  3 


[    66     ] 

ed  into  the  liver  by  the  hepatic  du6V, ^'ei- 
ther of  them  will  penetrate  into  the  gall 
bladder.  Now  as  fluids  of  fo  fubtile  a  na- 
ture as  thefe,  would  readily  pervade  thofe 
duds  if  they  exifted,  we  necefTkrily  conclude 
that  the  gall  bladder  receives  its  bile  by  the 
cyftic  duel. 

17.  BUT  the  caufes  which  determine  the 
retrograde  courfe  of  the  bile  from  the  duffus 
communis  into  th.e  gall  bladder  by  the  duftus 
cyfticusy  are  not  conftant  and  uniform  in  their 
operation  ;    they  admit  of  intervals,  during 
which  this  motion  of  the  bile   is  either  en- 
tirely fufpended,  or  changed  for  one  directly 
oppofite.     Were  it  not  fo,  the  gall  bladder 
would  be   in  a  conftant  ftate   of  furcharge, 
and  of  courfe  become  diftended  to  an  enor- 
mous fize,  fo  that  a  rupture  of  it  would  be 
endangered.  . 

18.  To  guard  againft  this  evil,  a  part  of 
its  contents  is  occafionally  difcharged,  from 
the  preflure,  which  the  furrounding  parts 


are  conftantly  making  on  it.  Thus,  this 
prefTure  will  vary  fomewhat  in  its  force  from 
the  relative  degrees  of  dtftention  of  the  fto- 
mach  from  food  :  and  when  the  ftomach  is 
diftended,  there  is  the  moft  copious  flow  of 
bile  into  the  duodenum. 

19.  By  this  mode  of  difcharging  the  con- 
tents, the  gall  bladder  is  confidered  as  apaf- 
five  receptacle.  But,  this  idea  has  been 
controverted;  at  leaft  it  has  not  always  been 
admitted  in  the  extent  here  flated.  Argu- 
ments, founded  on  analogy,  have  been  ad- 
duced to  prove  that  it  pofiefTes  fome  active 
power  on  its  own  contents ;  and  that  though 
affifted  by  the  prefTure  of  adjacent  parts,  as 
acted  upon  by  the  diaphragm  and  abdominal 
mufcles,  yet  that  there  is  inherent  in  it  a  pow- 
er, by  which  it  co-operates  with  thofe  agents^ 
and  relieves  itfelf  from  any  accumulation. 

2t>.  THE  analogy  here  alluded  to,  is  the 
urinary  bladder,  which,  by  its  own  mufcu- 
lar  power,  is  able  to  evacuate  its  contents. 

21.  DILIGENT  fearch  has  been  made  by 


[    68    ] 

anatomifts  to  difcover  mufcular  fibres  in  the 
gall  bladder,  and  fuch  a  ftrudture  has  been 
defcribed,  but  their  precife  dire&ion  is  not 
yet  agreed  upon.  This  difference  of  opinion, 
though  it  does  not  difprove  their  exiftence, 
yet  it  weakens  the  probability  of  it ;  for,  an 
appearance  fo  equivocally  and  indiftinctly 
marked,  as  to  admit  of  a  diverfity  of  defcrip- 
tion,  divides  the  mind  too  much  to  admit 
of  its  receiving  any  of  them. 

22.  THIS  difficulty  has  induced  anato- 
mifts to  adopt  another  criterion  of  mufcula- 
rity,  viz.  irritability;  and,  with  a  view, 
either  to  eftablifh  or  to  difprove  its  prefence, 
experiments  have  been  inftituted.  Various 
Simulating  powers,  both  chymical  and  me- 
chanical, have  been  applied  to  the  gall  blad- 
der, without  producing  any  evident  con- 
traction. Mechanical  Stimuli,  indeed,  pro- 
duce no  effect;  and,  when  any  contraction 
has  followed  the  ufe  of  chymical  application, 
it  has  been  confined  to  fuch  as  afted  by  a 


[     69     ] 

corroding  quality,  and  where  the  apparent 
contraction  has  been  nothing  more  than  the 
corrugation  which  may  be  induced  on  in- 
animate animal  matter.  Upon  this  fubject 
the  experiments  of  Baron  Haller  appear  to 
be  fufficient  and  decifive. 

23.  HAVING  explained  the  powers  by 
which  the  bile  is  conveyed  from  the  liver 
and  the  gall  bladder  into  the  duodenum,  we 
are  naturally  led  to  contemplate  the  means 
by  which  its  return  from  the  duodenum  is 
prevented. 

•24.  THE  contrivance  is  fimple  and  effec- 
tual. It  confitls  of  nothing  more  than  the 
oblique  manner,  in  which  the  common  bili- 
ary duct  pafTes  through  the  coats  of  the  intef- 
tine,  from  the  external  to  the  internal  fur- 
face,  and  by  which  the  office  of  a  valve  is 
performed  -,  fo  that  while  the  bile  has  a  free 
paflage  from  without  inward,  the  orifice  of 
the  duct  collapfes  when  a  contrary  direction 
is  attempted. 


25-  THE  caufes  which  impede  the  flow 
of  bile  into  the  duodenum  are  generally  very 
tranfient  in  their  operation,  under  which 
flate,  there  is  only  a  moderate  furcharge  of 
the  duels,  and  no  material  inconvenience  en- 
fues.  But  it  happens,  not  unfrequently, 
that  the  obftrudlion  is  of  a  permanent  nature, 
in  which  cafe  the  bile  is  necefTarily  detained 
in  thefe  parts  for  a  time,  after  which,  it  finds 
its  way  into  the  mafs  of  blood,  where,  by 
being  circulated  through  every  part  of  the 
body,  it  gives  yellownefs  to  the  fkin,  and 
producesjaundice. 

26.  THE  caufes  which  occafion  this  ob- 
flruction  are  various.  A  very  common  one 
is  the  prefence  of  a  gall  ftone  either  in  the 
hepatic  or  common  dud  ;  perhaps  the  lat- 
ter is  more  general,  as  biliary  calculi  form 
more  frequently  in  the  gall  bladder,  where 
the  bile  is  in  a  ftate  of  quiefcence,  than  in 
the  branches  of  the  hepatic  duel,  where  it  is 
in  motion, 


•       [    7'     ] 

27»  SOMETIMES  a  flriftureof  the  common 
duct  is  an  obilrudling  caufe ;  fuch  as  have 
been  difcovered  after  death,  are  ufually  of 
that  permanent  kind  connefted  with  a  dif- 
eafed  condition  of  that  part,  a.  removal  of 
which  can  fcarcely  be  hoped  for. 

28.  BUT  a  caufe  of  jaundice  has  been  re- 
ferred to  a  fpafmodic  flrifture  of  this  duel, 
and  which,  as  not  being  connected  with  a 
change  of  organization,  may  attack  by  par- 
oxyfms,  returning  at  indeterminate  periods. 

29.  WITHOUT  examining  into  the  fymp- 
toms  which  have  been  fuppofed  to  character- 
ife   this  caufe ;   it   may  poflibly  be  thought 
a  fufficient  refutation  to   prove,    that   the 
biliary  duels  of  a  living  animal  poflefs  no 
marks  of  irritability  when  afted  upon    by 
ftimuli ;   the  contrary  of  which  we   fhould 

expect  were   they  furnifhed  with   mufcular 
fibres. 

The  only  part  of  the  common  duct  liable 
to   fpafmodic  affection  is  that  which  pafles 


[      72      ] 

through  the  coats  of  the  duodenum,  which 
may  be  acled  upon  by  the  mufcular  fibres 
of  that  inteftine  ;  and  here  we  fhonld  dif- 
tinguifti  between  the  contraction  of  the  in- 
teftine in  which  the  biliary  duel  is  pailive, 
and  a  contraclion  of  the  duel  itfelf. 

30.  ANOTHER    caufe   of   obftrucled  bile 
confids    in  a   prefiure   of  the  duel   by    the 
head  of  the  pancreas,  which  is  fometimes 
found  in  a  fchirrous  (late,    and  which,    from 
its  connection,    may  eafily  produce  fuch  an 
-effecl :  for  the  biliary  duel,    a  little  before 
it  terminates     in  the   intefline,   penetrates 
fome   way  into  the  fubftance  of  the  pan- 
creas,  and  receives  the   excretory  duel   of 
that  gland.      Therefore  the   orifice  which 
appears  on  the  inner  furface  of  the  duode- 
num  tranfmits,    in    common,  the   bile  and 
pancreatic  fluid. 

31.  To  thecaufes  of  obftruclion  already 
enumerated,    there    is   another    fometimes 
annexed  ;    viz.  a  fchirrous  impacled  ftate  of 
the  liver,  which  from  a  very  extenfive  depo- 


E    73    3 

fit  of  folid  matter  throughout  its  fubftance, 
in  an  interftitial  form,  diminifhes  the  capa- 
cities of  the  for  i  biliariiy  fo  that  they  are 
unable  to  carry  off  the  bile  as  fad  as  fe- 
creted,  and  an  accumulation  of  it  within 
the  fubftanceof  the  liver  muft  therefore  ne- 
ceflarily  enfue. 

32.  HITHERTO   the  caufe  of  jaundice  has 
been  referred  to  obftru&ion  in  fome  part  or 
other  of  the  biliary   duels.     But   there   are 
fome  cafes  which  incline  us  to  believe  that 
jaundice    may  exift,  though  the   biliary  ca- 
nals are  pervious  and  free. — The  yellow  fe- 
ver of  the  Weft  Indies  furnifhes  an  inftance 
in  point.     The  charadters  of  this  complaint 
are  a  diffufion  of  bile  through  the  mafs  of 
blood,  producing  jaundice,  with  an  exceflive 
quantity  of  it  in  the  alimentary  canal,    fo 
that- it  is  difcharged  by  vomiting  and  purg- 
ing.    In  this  cafe  jaundice  feems  to  depend 
upon  a  redundant  fecretion. 

33.  BUT    Boerhaave  and  Morgagni  have 

H 


[    74    ] 

favoured  an  opinion  the  direct  reverfe  of 
this.  They  confider  jaundice,  fometimes, 
as  the  effect  of  a  fufpended  fecretion,  and 
fuppofe  that  the  blood,  in  confequence  of 
this,  retains  a  bilious  character,  thereby 
giving  ayellownefs  to  the  Ikin. 

34.  THIS  opinion  is  founded  on  a  miftak- 
cn  notion,  that  all  the  iecreted  fluids  pre- 
exift  in  the  mafs  of  blood ;    and    that  the 
province  of  the  different  glands  is  confined 
to  the  more  mechanical  feparation  of  thofe 
fluids. 

35.  As   there   are   few,    if   any,    phyfio- 
logifts,    of  the  prefent  day,    who    entertain 
fuch  an  opinion  of  glandular   fecretion,  to 
offer  any  thing  of  an  argumentative  nature, 
by  way  of  refutation,  would  be  altogether 
fuperfluous.     It  is  now  generally  underflood 
and  believed,   that  the  blood  is  the  fabulum 
or  fource  of  all  the  fecretions,    and  that  the 
glands  through  which  it  circulates,  change 
its   properties,  every  one   according  to   its 


[    75    ] 

peculiar  mode  of  action  j  fo  that  the  fecre- 
tions  may  be  confidered  as  new  fluids  formed 
by  their  refpective  glands. 

36.  IF  this  idea  of  fecretion  be  true,  it 
muft  necelTarily  follow,   that,  if  the   aftion 
of  the  whole  fecreting   fyftem  of  the  liver 
be  arrefted,    no  bile    can    be    formed,   and 
confequently   none    can    be  conveyed    into 
the   mafs   of  blood.      To  argue   otherwifc 
would  be  to  oppofe  every  principle  of  rea- 
foning ;   it  would  be  imputing  effects  to  a 
caufe  which  has  no  exiftence. 

37.  IN  every  cafe  of  jaundice  bile   muft 
be  fecreted  and  carried  into  the  blood   vef- 
fels  ;  but  the  channel  by  which  it  is  convey- 
ed has  given  rife  to  controverfy. 

38.  THERE  are  on  this  fubject  two  opini- 
ons  which  divide   phyfiologifts  ;    fome  of 
whom  affert,    that  the  bile  after  fecretion  is 
carried  to  the  blood  veiTels  by  regurgitation> 
whilft  others   attribute    this   effect   to  ab- 
forption. 

H  2 


[    76    ] 

The  firfl  opinion  has  moft  generally  pre- 
vailed. 

39.  BARON    HALLER,    who     introduced 
this  to  our  notice,   refts  his  opinion  on  the 
free  communication    of  veiTels  in  the  inte- 
rior part  of  the  liver;  but  more  efpecially 
on  a  communication   between   the  hepatic 
veins  and  biliary  duels.     The  proof  of  this 
communication  is  fair  and  decifive. 

40.  HE  obferves  that  a  fubtile  injection 
thrown  in  by  the  hepatic   duel  will   efcape 
readily  by  the  hepatic  veins.     This  is  a  fact  •> 
and  I  know  from  experiment  that  water  in- 
jected in  the   fame  direction  will  return  by 
the  veins  in  a  full  ftream,   though  very  little 
force  is  ufed.     From  the  facility  with  which 
water  takes  this  retrograde  courfe,  a  proba- 
bility arifes,    that,  if  from  any  caufe  the  na- 
tural direction  of  the  bile  be  obftructed,  it 
will  naturally  obey  the  fame  direction. 

This  explanation  of  jaundice  feemed  ful- 
ly fufficient  tofatisfy  the  mind  of  Baron  Hatter. 


f    77    ] 

41.  BUT  a  more  extend  ve  acquaintance 
with  the  ceconomy  of  the  abforbent  fyftem 
has   given  a  new  turn  to  this  fpeculation, 
and  has   induced  a  phyfiologift  of  the  pre- 
fent  day,   to  folve  the  caufe  of  jaundice  on 
the  principle   of    abforption    only.      This 
opinion  reits  on   an    experiment  where  the 
hepatic  duct  of  a  living  animal  was  tied,  and 
afterwards  the  abforbents  of  the  liver   were 
very  much  loaded  with  bile. 

42.  THIS  fact  certainly  proves   that  the 
abforbents   have   the   power  of   taking   up 
bile;     a  circumftance  which    I  apprehend 
would  be  generally  admitted,  though  it  had* 
not  received  the  confirmation  of  experiment. 
But  it  does  not  invalidate  the  probability  of 
a  part  paffing  into  the  blood  veflfels  by  the 
hepatic  veins  3  the  circumftances  'and  facts 
upon  which  that  opinion  refts,    retain  all 
their  original  force,   and  ftand  unaffected  by 
this  experiment. 

43.  THE  queftion  then  feems  to  be,  \vhe- 

H3 


[    78    3 

therm  cafes  of  jaundice  the  bilepafies  into 
the  blood  veflels  by  regurgitation,  by  ab- 
forption,  or  by  both  channels  ? 

44.  THAT  the  abforbents  take  up  the  bile 
from  the  interior  part  of  the  liver,  and 
convey  it  by  the  thoracic  duel  into  the  mafs 
of  blood,  the  following  experiment  will 
evince. 


EXPERIMENT. 

45.  AN  incifion  was  made  into  the  abdo- 
men of  a  living  dog,  large  enough  to  allow 
a  ligature  to  be  made  on,  the  hepatic  du£t; 
this  being  done,  the  parietes  of  the  abdomen 
were  brought  together  by  futures.  Two 
hours  after,  the  dog  was  Strangled,  and 
the  parts  carefully  examined.  On  infpeftion 
it  appeared  that  the  abforbents  had  been 
very  active,  for  they  were  very  much  diften- 


[    79    1 

ded  with  a  fluid  of  a  bilious  colour,  and 
their  courfe,  which  was  very  confpicuous, 
could  be  traced  with  the  greateft  eafe  to  the 
thoracic  duel,  the  contents  of  which  feemed 
only  moderately  bilious.  The  bilious  co- 
lour was  in  a  great  meafure  concealed  by 
the  red  particles  of  blood,  which  had  been 
extravafated  by  the  injury,  taken  up  by  the 
abforbents,  and  conveyed  into  that  canal. 
It  is  probable,  however,  that  the  bile  was 
only  juft  entering  the  blood  veflels,  as  on 
a  very  careful  infpection  of  the  eye,  the  tu- 
nica conjunctiva  did  not  betray  the  flighted 
appearance  of  jaundice, 

4^.  IT  feems  then  that  during  the  ipacc 
of  two  hours,  the  fccretion  of  the  liver 
had  been  fufiicient  in  quantity  to  diftend 
its  ducts ;  to  flimulate  the  abforbents  to 
relieve  that  diftention  ;  and  to  allow  of  a 
final  1  portion  of  their  contents  to  be  con- 
veyed into  the  blood  veflels. 

47,  BUT   it  Hill  remains  to  determine, 


[    8o    ] 

whether  or  not  a  fmall  quantity  of  bile  wa* 
not  regurgitating  by  the  hepatic  veins  dur- 
ing the  procefs. 

48.  To  afcertain  this,  a  fecond  dog  was 
procured,  and  a  ligature  made  on  the  he- 
patic duel  as  in  the  preceding  experi- 
ment. Two  hours  after,  blood  was  taken 
from  the  jugular  vein,  and  fet  to  reft,  in 
oider  that  it  might  feparate  into  its/erum  and 
crajjamentum.  The  liver  was  then  drawn 
down  a  little  from  the  diaphragm,  and  blood 
taken  from  one  of  the  hepatic  veins.  This 
blood,  as  well  as  the  former,  was  allowed 
to  feparate  into  parts  :  and  on  immerfmg 
pieces  of  white  paper  into  the  ferum  of 
each,  that  taken  from  the  hepatic  veins 
gave  the  deepefl  tinge,  the  other  produced 
only  a  very  (light  degree  of  difcoloration. 

49.  IN  this  experiment  the  period  of  ex- 
amination was  the  fame  as  the  la  ft,  viz. 
two  hours;  a  fpace  of  time  jufl  fufficient 
for  the  bile  to  begin  to  make  its  way  into 


the  circulation  without  having  poured  In 
fuch  a  quantity  as  to  tinge  in  any  fenfible 
degree  the  general  mafs  of  blood.  Hence 
we  fee  evidently  why  the  blood  which  was 
returning  from  the  liver  by  the  hepatic 
veins,  contained  a  larger  proportion  of  bile 
than  that  taken  from  the  general  circulation. 
50.  As  the  firft  of  thefe  experiments 
proves,  that  the  abforbents  of  the  liver  are 
concerned  in  the  production  of  jaundice,  fo 
the  laft  demonftrates  with  equal  force,  that 
when  from  the  operation  of  any  obftrucling 
caufe  the  bile  is  accumulated  in  its  duels, 
fo  as  to  diftend  them  in  a  confiderable  degree, 
Nature  relieves  herfelf,  in  part,  by  allowing 
a  portion  of  it  to  take  a  retrograde  courfe  by 
the  hepatic  veins. 


83 


CHAP.    VII. 


BILE. 


SECT.   I. 

JL  K  i  s  fluid,  upon  bare  infpection,  is  ap- 
parently homogeneous ;  of  a  green  colour, 
in  which  a  yellow  fhade  is  very  confpicuous 
when  the  bile  is  diluted  with  a  watery  fluid  ; 
but  if  examined  in  its  moreconcentrated  (late, 
is  of  a  deep  green.  Hence  it  is  that  the 
dilution  of  this  fluid  by  the  more  watery 
parts  of  the  blood  gives  the  yellownefs  of 
jaundice. 


[    84    ] 

2.  THE  confidence  of  bile  is  ufually 
vifcid,  and  its  tenacity  is  fometimes  fuch, 
that  it  cannot  be  poured  from  a  phial  in 
drops,  but  is  drawn  out  into  threads  like 
the  albumen.  It  is  obferved  to  be  more 
vifcid  in  the  human  fubject  than  in  brute 
animals. 

3.  BUT  a  queftion  may  here  arife,  how 
far  this  tenacity  is  eflential  to  the  bile,  or 
whether  it  may  not  be  explained  on  the  prin- 
ciple of  its  being  a  compound  fluid,  con-  • 
fitting  in  part  of  genuine  bile,  with  a  por- 
tion of  that  mucus  which  is  fecreted  by  the 
gall  bladder  •>  for  it  is  the  bile  contained  in 
this  receptacle,  which  is  ufually  the  fubject 
of  chymical  experiment. 

4.  WHEN  bile  is  agitated  in  a  phial,  it 
forms  a  lather  in  the  form  of  foap  and  wa- 
ter ;  and  that  it  really  pofTefles  faponaceous 
properties  is  rendered  highly  probable  from 
the  ufe  to  which  it  is  applied  by  fcourers  ot 


cloth ;  it  being  known  to  afiifl  very  power- 
fully in  the  removal  of  greafy  fpots. 

5.  To  thefe  fenfible   properties  we   may 
add  its  tafte  and  fmell ;    the  firft   being  in- 
tenfely  bitter,  with  a  degree  of  pungency  5 
the  laft  of  a  faint  and  naufeous  nature. 

6.  FROM  this  ailemblage  of  properties,  we 
naturally  prefume,  that  bileisafaponaceous 
fluid  combined  with  a  mucilaginous   fub- 
Itance,  from  which  it  receives  its  tenacity; 
and  to  thefe  are  fuperadded  the  green  colour- 
ing matter  and  the  principle  of  bitternefs. 

7.  IT  is*  therefore  the  province   of  chy- 
miftry  to  determine,  by  careful  and  accurate 
inveftigation,   in  what   degree  thefe  conjec- 
tures concerning  the  nature  of  that  fluid^can 
be  confirmed  by  experiment. 

8.  IN  the    firft   dawnings   of    chymicai 
knowledge,  when  our   acquaintance     with 
the  agents  of  chymiftry,  and  their   effects 
on   matter,   was   narrow  and  confined,  the 
means   ufually  employed   to   afcertain  the 


[    86    ] 

component  parts  of  bodies,  were  feldom  any 
other  than  thofe  of  fubjecting  them  to  dif- 
dilation  by  different  degrees  of  heat,  from 
the  lefs  violent  to  the  more  intenfe.  Hav- 
ing exerted  the  whole  power  of  the  furnace 
in  this  way,  the  inquirers  thought  themfelves 
in  pofieflion  of  a  very  perfect  analyfis  of 
every  body,  which  they  thus  fubmitted  to 
invefligation. 

BUT  reflection  and  an  extended  ftate  of 
knowledge  foon  convinced  them  how  re- 
mote they  were  from  a  thorough  acquaint- 
ance with  the  conftituent  parts  of  bodies  ; 
and  their  unfuccefsful  attempts  to  reproduce 
the  original  fubftance,  by  a  recombination 
of  fuch  of  its  elements,  as  they,  in  this  way, 
were  able  to  collect,  foon  convinced  them, 
that  another,  and  lefs  fallible,  mode  of  pro- 
fecuting  thefe  inquiries  was  very  much  to 
be  wifhed. 

10.  BESIDES,  they  were  not  acquainted 
with  the  nature  of  the  agent  they  employed, 


dther  abftractedly,  or  in  a  flate  of  combi- 
nation with  matter ;  therefore  the  changes 
thus  induced  could  be  but  imperfectly  un- 
derftood. 

11.  To  guard  againft  this  difficulty,  ano- 
ther, and  more  natural,  mode  of  inveftigat- 
ing  bodies  was  introduced,  viz.  the  forming 
of  different  compounds  by  the  addition  of 
certain  chymical  re-agents  -,    and  in  this  way 
it  was   found  that  a   more    correct   analyfis 
could  be  obtained.     Thus  the  torturing  of 
bodies  by  the  application  of  beat  neceflarily 
yielded  to  the  more  natural  examination  by 
chymical  attractions. 

12.  IT  is  by  no  means   intended  here  to 
profcribe  altogether  the  agency  of  beat,    it 
being  often  found   eflentially  ufeful,  as  an 
auxiliary,  to  the  chymical  bodies  employed, 
enabling  them  the  better  to  effect  their  dif- 
ferent decompofitions  and  combinations. 

13.  AQJJANTITY   of  recent  ox  bile  being 
procured,  feveral  experiments  were  inftitut- 


[    88    ] 

ed,  with  a  view  to  afcertain  its  component 
parts. 


EXPERIMENT    I. 

14.  A  PORTION  of  it,  being  received  into 
a  (hallow  earthen  veflel,  was  evaporated  cau- 
tioufly  by  a  moderate  heat.    On  examining 
the  vapour,   it   appeared   to  be  principally 
water  pofTefTing  neither  acid   nor  alkaline 
properties,   but  •ftrongly  impregnated  with 
that  principle,    in  which  the  peculiar  odour 
of  bile  chiefly  refides.     The  refiduum  gradu- 
ally  infpiffates  and  affumes  the  form  of  an 
extract  >  which,  if  the  evaporation  be  carried 
fufficiently  far,  will   become   as  brittle  as 
refin,  and  may  be  pulverized  with   equal 
eafe. 

15.  FROM  this  experiment  we  learn  that 
the  fluidity  of  bile  depends  chiefly  on  aqueous 


matter,  and  that  in  the  exhalation  of  it,  even 
by  the  more  moderate  degrees  of  heat,  it  is 
accompanied  by  the  odorous  principle, 
which,  it  feems,  is  of  a  very  volatile  nature. 
1 6.  As  bile  poflefles  a  confiderable  degree 
of  tenacity,  and  as  the  tenacity  of  animal 
fluids  depends  chiefly  on  a  mucilaginous 
principle,  it  was  determined  next  to  afcer- 
tain  whether  that  principle  gives  vifcidity  to 
the  bile. 


EXPERIMENT    II, 

17.  ON  a  portion  of  bile  was  poured  a 
quantity  of  alcohol ;  a  coagulum  was  imme- 
diately formed,  which  -floated  in  a  green 
liquor.  On  filtering  this  compound  the 
green  fluid  readily  pafled,  while  a  mucila- 
ginous fubftance  of  confiderable  tenacity  was 
detained  by  the  paper.  This  mucilage  was 
1  3 


[     90    ] 

of  a  whitifh  colour,  and  pofTefled  only  a 
flight  degree  of  bitternefs,  while  the  filtrat- 
ed liquor  preferved  both  the  bilious  co- 
lour and  tafte.  It  is  fcarcely  necefTary  to 
add,  that  it  was  free  from  vifcidixy.  The 
GLUTINOUS  principle  of  the  bile  appears 
then  to  refide  in  an  animal  mucilage. 

1 8.  THE  fluidity,  odour,  and  vifcidity  of 
bile  being  thus  accounted  for,  we  are  next 
led  to  the  inveftigation  of  the  principles  on 
which  its  bitternefs,  colour,  and  fapona- 
ceous  quality,  depend. 


EXPERIMENT   III. 

19.  To  a  quantity  of  recent  bile  was  add- 
ed a  diluted  marine  acid;  a  coagulation  was 
produced.  The  fluid  feparated  by  the  filter 
was  of  a  green  colour,  but  much  lighter 
than  that  of  bile;  and,  notwithitanding  the 


predominance  of  the  acid,    the  bitter  taflc 
was  very  diftinguifhable. 

20.  THE  more  folid  matter  detained  by 
the  filter  was  very  glutinous,  of  a  green 
colour,  and  intenfely  bitter. 


EXPERIMENT  IV. 

21.  Two  other  portions  of  bile  were  put 
into  proper  veflels ;  to  one  was  added  a  di- 
luted vitriolic,  to  the  other  a  diluted  nitrous 
acid.     Both  exhibited  phenomena  fimilar  to 
thofe  in  the  laft  experiment.     The    filtrat- 
ed liquors   were  green,  and  bitterifh  j  the 
coagula  intenfely  fo,  and  glutinous. 

22.  As,    in   thefe  experiments,    the  de- 
compofition  appeared  to  be  incomplete,  it 
was  thought  eligible  to  try,  whether  or  not 
a  more  perfect  feparation  might  be  obtained 
by  the  aflutance  of  heat, 


C     9*     1 


EXPERIMENT  V. 


23.  A  QUANTITY  of  bile  and  diluted 
marine  acid  were  put  into  a  flafk,  and  pla- 
ced in  a  fand  bach  until  they  had  acquired 
the  boiling  heat.  On  infpedtion,  the  fepa- 
ration  into  parts  was  very  evident  -,  and  on 
committing  it  to  the  filter,  it  feparated  a 
colourlefs  fluid  deftitute  of  every  bilious 
property.  The  refiduum  confided  of  a  very 
dark  green  mafs,  intenfely  bitter,  and  ex- 
tremely glutinous.  When  examined,  it  ap- 
peared to  be  compofed  of  an  animal  muci- 
lage, in  combination  with  a  refinous  fub- 
ftance. 

24.  BUT  to  afcertain  in  what  way  the 
acid  had  effefted  the  decompofidon,  it  be- 
came necefTary  to  examine  the  filtrated  li- 
quor. It  was  therefore  iiibjecled  to  a  cau- 


[    93    ] 

tious  evaporation,    and,  at  a  proper  period, 
was  fuffcred  to  cool. 

25.  UNDER  cooling,  cryftals  were  form- 
ed  of  a   cubic  figure,    which  decrepitated 
by  heat,  and  pofiefTed  all  the  characters  of 
common  fait. 

Therefore  the  decbmpbfition  was  here 
occafioned  by  the  marine  acid  engaging  the 
mineral  alkali,  which  it  feparated  from  the 
other  element  of  the  faponaceous  body, 
and,  by  uniting  with  that  bafis>  formed  com- 
mon fait. 

26.  BUT,    notwithflanding   we   are   able 
to  account  for  the  production  of  common 
fait  in    this  way,    it   does  not   exclude    the 
poflibility  of  a-  fmall  quantity    of  it   pre- 
exifting  in  the  bile,  independent  on  this  ar- 
tificial coaibination  of  its  elements.  . 

27.  To   fatisfy  my  doubts  on  this   point, 
the  following  experiment  was  made. 


[    94    ] 


EXPERIMENT  VI. 

28.  To  a  portion  of  bile  was  added 
alcohol,  in  quantity  fufHcient  to  fetloofe  all 
its  mucilaginous  matter.  The  fluid  part, 
being  feparated  by  a*  filter,  was  examined 
by  nitrated  filver,  but  no  luna  cornea  was 

produced :    therefore  the  marine  acid  (the 

^ 

acid  principle   of  common   fait)  does  not 
appear  to  have  any  exiftence  in  the  bile. 

19.  FROM  this  experiment  we  learn,  that 
the  faline  bafis  of  the  faponaceous  matter 
of  the  bile  is  the  mineral  alkalis  but  the 
other  element  isflill  a  queftion. 


EXPERIMENT  VII. 

30.  To  determine  this  point   a  quantity 
of  bile  was  decompofed  by  a  diluted  marine 


I    95    I 

acid,  aflifted  by  heat  (as  in  Experiment  V.) 
The  coagulum  detained  by  the  filter  was  ex- 
amined. It  appeared  to  poflefs  moft  of  the 
charadters  of  bile  in  a  folid  concentrated 
flate.  It  had  a  pungent  bitter  tafte,  dark 
green  colour,  and  was  extremely  glutinous. 
When  perfectly  dry,  it  was  very  inflamma- 
ble, and  burned  with  as  much  rapidity  as 
any  bituminous  fubftance  would  do. 

31.  THIS  appearance  led  to  a  fufpicion  of 
the  prefence  of  a  refin,  but  as  a  higher  de- 
gree of  certainty  was  ftill  wilhed  for,  further 
experiment  was  necefTary. 


EXPERIMENT  VIII. 

32.  I  THEREFORE  diffufed  a  portion  of 
this  refiduum  through  rectified  fpirit  of  wine : 
a  large  proportion  of  it  was  diflblved, 


C  96  ] 

which  imparted  to  the  fpirit  both  the 
colour  and  tafle  of  bile;  the  infoluble 
part  being  chiefly  of  a  mucilaginous  na- 
ture. 

33.  FROM  the  facility  with  which  alcohol 
difTolves  the  green  and  bitter  part,    it  is 
fcarcely   probable,   that  it  partook  of  the 
nature  of  an  un&uous  oil ;  but  that  it  was 
either  a  refinous  body,  or  a  kind  of  efTential 
oil. 

34.  THIS  point  was  eafily  determined  : 
for, "on  the  addition  of  water  to  the  folu- 
tion,     a    precipitation   took  place.      The 
filtered  liquor  was  colourlefs  and  free  from 
bitternefs.     The  refiduum  was  nothing  more 
than  a   refinous  fubftance,    in  which  refided 
both  the  colouring  principle  and  bitter  tafle. 

35.  ON  taking  a  retrofpec~l  of  the  above 
experiments,   the  bile  appears  to  be  refolv- 
able  into  the  following  elements,  viz. 

Firft, Water,    impregnated  with  the 

odorous  principle. 


C    97    1 

Secondly, A  mucilaginous  fubflancc 

refembling  the  albumen. 

Thirdly, — -A  refinous  fubftance  contain- 
ing the  colouring  principle  and  bitter  tafte. 
And 

Fourthly, — The  mild  mineral  alkali. 

36.  WITH  refpect  to   their  combination-, 
it  feems  that  the  faponaceous  matter  confifts 
of  the  bitter  refin  in  union  with  the  alkali : 
this  admits  of  a  ready  union  with  a  mucilage,, 
and  with  this  again  the  aqueous  matter  very 
cafily  combines,  fo  that  the  whole  forms  a 
mafs  apparently  homogeneous. 

37.  THE  following  experiments  were  in- 
ftituted   with   a  view   of  examining  fome 
doctrines,    founded  on   the  bile   having  a 
greater  power  of  refilling  putrefaction  than 
the  blood. 


EXPERIMENTS   IX  &f  X. 

38.  E(*yAL  quantities  of  blood  and  bile 
of  the  fame  ox  were  each  put  into  a  dif- 
ferent veiTel  of  the  fame  fize,  and  expofed 
to  the  fame  degree  of  heat.  On  the  third 
day.  the  blood  began  to  give  out  by  its 
odour,  marks  of  putrefaction ;  the  bile 
remained  in  its  natural  ftate. — On  the  fourth 
day  the  bile  had  a  pungent  odour  by  no 
means  ungrateful,  while  the  blood  was 
extremely  putrid. — On  the  fixth  day  the 
bile  became  putrid,  and  had  a  very  offen- 
live  fmell. 


[     99     j 


CHAP.     VIII. 


ON  BILIARY  CALCULI. 


SECT.     I. 


favoured  by  Dr.  Baillie  with  an 
opportunity  of  examining  the  ftructure,  and 
general  appearance  of  biliary  calculi^  in  his 
collection  I  found  that  they  are  very  gene- 
rally either  of  a  lamellated  or  radiated  ftruc- 
ture  :  on  the  outer  furface  chiefly  of  the 
former  ;  on  the  inner  of  the  latter.  The 
colour  is  extremely  various  :  in  fome  they 
are  of  a  light  colour,  approaching  to  a 

K  2 


.0      ] 

white ;  in  others  as  black  as  jet  ;  in  many 
of  a  brown  or  ochry  appearance  :  thefe  laft 
have  generally  a  very  bitter  tafte ;  the  radi- 
ated part  is  frequently  white,  and  without 
tafte. 

2.  THEY  are,  very  generally,  inflamma- 
ble, and  fufible  in  the  fire  -,   and,  for  the 
moil  part,  they  are  foluble  in  fpirit  of  wine, 
and  oil   of  turpentine.      There  are   fome, 
however,  which  are  not  foluble  in  either  of 
thefe  fluids.     Many  of  them  have  the  con-* 
fiftence  of  phosphorus,  and  cut  like  wax. 

3.  IN  the  radiated  calculi  there  is  a  fub- 
ftance,    in    every  refped,    like  Spermaceti. 
Some  calculi^    inflead  of    burning  with    a 
flame,  only  become  red,  and  confume  to  an 
afh,  like  a  cinder. 

4.  THIS    variety  in  the   appearance   of 
calculi    clearly    evinces   that   they   are  not 
mere  infpifTations  of  bile,    but  that  there 
is   a   difference    either   in   the  component 


parts  themfelves,   or  in   the  proportion  of 
thofe  parrs. 

5.  THEREFORE,   in  chymical  inveftigati- 
on,  itfeems  neccffary  that  experiments  ftiould 
be   made  on    different   fpecimens,  as  it   is 
probable,   even  a  priori,  that  the   refult   of 
experiments  made   on    one  fpecimen,  will 
not  apply,  very  ftri&ly,  to  a  feries  of  inqui- 
ries made  on  another. 

6.  As  we  prefume,  from  bare  infpeclion, 
that  thefe  calculi  are  not  mere  infpiffations 
of  bile,    but  that   they   contain   principles 
which  are  not  to  be  found  in   that  fluid,  it 
affords  a  fubject  of  rational  inquiry,    to  de- 
termine what   are   thofe   elements,    and  of 
what  nature  is  their  combination. 

7.  To  afcertain  this,  feveral  experiments 
were  inftituted  on  a  calculus  of  the  follow- 
ing characters. 

The  external  furface  was  of  a  chocolate 
colour  j  when  rubbed  off,    it   had  a  lighter 
coloured  layer  underneath. 
*  3 


On  making  a  fection  through  its  centre^ 
it  appeared  to  be  compofed  of  lamellae. 

It  was  rubbed  to  powder  very  eafily. 

Its  tafte  was  moderately  bitter. 

It  was  fufible  by  heat,  and  when  inflamed^ 
burned  like  a  refinous  fubftance. 

Ol.  terebinth,  unaided  by  heat,  diflblved 
a  very  large  portion  ;  but  alcohol,  under 
the  fame  circumftances,  diflblved  only  a 
fmall  part. 

8.  To  determine  how  far  the  agency  of 
heat  could  affift  the  folvent  power  of  alco- 
hol, an  experiment  was  made. 


EXPERIMENT. 

TWENTY  grains  of  this  calculus  were 
infilled  in  an  ounce  of  alcohol,  and,  after 
previous  agitation,  the  phial  was  placed  in 
a  fand  bath.  Before  the  fluid  had  arrived 


[     I03    I 

at  the  boiling  point,  it  diflblved  nearly  the 
whole  of  the  fubftance.  The  clear  liquor, 
being  poured  from  the  refiduum,  was 
fuffered  to  cool.  Under  cooling,  the  whole 
afTumed  the  appearance  of  a  foiid  chryftal- 
lized  mafs. 


EXPERIMENT. 

9.  A  SMALL   quantity   of  alcohol    being 
poured   on  this  refiduum,    and  aflifted   by 
heat  as  before,  exhibited  very  little  folvent 
power.     Thefe  experiments  fhow  that  there 
is  a  fmall  proportion  of  this  biliary  calculus 
which  refills  the  folvent  power  of  alcohol. 
What  is  its  nature  ? 

EXPERIMENT. 

10.  To  this  refiduum  was  added  a  quan- 
tity of  diluted  marine  acid,      A  fufficient 


104 

time  having  elapfed,  the  fluid  was  commit- 
ed  to  the  filter.  To  the  clear  liquor  was 
added  a  portion  of  the  aq.  kali,  and  a  white 
precipitation,  apparently  of  an  earthy  na- 
ture, immediately  took  place.* 

Hence  one  point  in  which  a  biliary  cal- 
culus differs  from  fluid  bile  is,  in  contain- 
ing a  quantity  of  earthy  matter. 

ii.  THE  cryflallized  mafs  formed  by  the 
alcohol  was  next  fubjected  to  examination. 
Some  of  the  phenomena  already  related 
having  led  to  a  fufpicion,  that  a  refinous 
matter  forms  one  of  the  conftituent  parts  of 
biliary  calculi,  the  proof  of  it  was  referved 
for  the  following  experiment. 


EXPERIMENT. 

12.  THE  thryftallized  mafs,   being  made 

*  I  fufpeft  it  to  be  of  an  earthy  nature,  not 
only  from  its  folubility  in  an  acid>  but  from  its 
pofTeiling  no  inflammability. 


[     <°5     I 

fluid  by  heat,  was  poured  into  a  pint  of  wa- 
ter -,  a  white  flocculated  precipitate  was  im- 
mediately formed,  leaving  an  opaque  fuper- 
natant  liquor.  The  whole  was  committed 
to  the  filter,  and  the  folid  part  being  col- 
ledled  and  dried,  was  found  to  be  of*  a  refi- 
nous  nature. 


EXPERIMENT. 

13.  To  the  clear  filtered  liquor  was  added 
a  fmall  quantity  of  diluted  marine  acid, 
from  a  fufpicion  that  an  alkaline  principle 
might  form  one  of  the  conftituent  parts  of  a 
gall  (lone,  as  well  as  of  the  bile,  and  by  that 
means  a  fmall  portion  of  the  refinous  fub- 
ftance  might  ftill  be  held  in  folution  ;  but 
no  precipitation  followed.  This  experiment 
makes  the  prefence  of  an  alkali  fomewhat 
equivocal ;  but  the  following  proved  its  ex- 
iftence  very  fatisfactorily. 


[     106     ] 

EXPERIMENT. 

14.  THE  fluid  mixture  of  the  laft  experi- 
ment was  carefully  evaporated  almoft  to 
drynefs.  On  cooling,  two  kinds  of  cryf- 
tals  formed ;  one  fpiculated,  the  other  cubic. 
The  cubes,  poflefling  the  characters  of  com- 
mon fait,  proved  the  prefence  of  the  mineral 
alkali  :  and  the  fpiculated  cryftals,  which 
were  the  common  crude  fal  ammoniac,  af- 
forded prefumptive  evidence  in  favour  of 
the  volatile  alkali.  But  what  placed  the 
matter  beyond  doubt  was  the  following  ex- 
periment. 


EXPERIMENT. 

15.  A  DROP  or  two  of  aq.  kali  was  added 
to  thefe  cryftals,  and  the  volatile  alkali  be- 
came immediately  fenfible. 


E    107   ] 

1 6.  FROM  thefe  experiments  we  infer, 
that  this  fpecimen  of  biliary  calculus  con- 
fided chiefly  of  a  refmous  matter,  with  a 
fmall  proportion  of  earth,  apparently  calca- 
reous, combined  with  the  mineral  and  vola- 
tile alkali. 


I   109  ] 


C  HAP.     IX. 


OF  THE  USE  OF  THE  BILE. 


SECT.    I. 


G 


E  E  N  and  bitter  bile  being  in  common 
to  all  animals  with  red  blood,  and  found 
only  in  fuch,  makes  it  probable  that  there  is 
forne  relative  connexion  between  this  fluid 
and  the  colouring  matter  of  the  blood,  by 
the  red  particles  contributing  more  efpec: al- 
ly to  its  formation.  An  opinion  very  gene- 
rally prevails,  that  the  bile  affifts  in  the  pro- 
cefs  of  chylification,  by  mixing  with  the 
L 


[       110      ] 

digefted  food  contained  in. the  duodenum: 
for  it  is  demonftrably  true,  that  the  digefted 
matter  does  not  aflume  a  chylous  form  un- 
til it  has  patied  below  that  part  of  the  in- 
teftine  where  the  biliary  and  pancreatic 
duels  make  their  entrance.  And  upon  the 
ground  of  this  fact,  it  has  been  prefumed, 
rather  than  demonftrated,  that  either  all, 
or  fome  of  the  conftituent  parts  of  the  bile 
contribute  to  chylification.  What  founda- 
tion exiils  for  fuch  an  opinion,  the  following 
experiment  will  tend  to  fhow. 


EXPERIMENT. 


2.  A  DOG  was  fed  with  animal  food,  and 
in  three  hours  the  abdomen  was  opened. — A 
portion  of  the  duodenum,  and  jejunum  of 
confiderable  length,  was  cut  open,  fo  that 


[  III  ] 

the  contents  might  be  obferved.  Portions 
of  food,  reduced  to  a  pultaceous  mafs,  were 
feen  oozing  through  the  pylorus ;  the  bile 
was  likewife  obferved  to  pafs  (lowly  out  of 
its  dud,  which,  when  carefully  attended 
to,  appeared  to  flow  over  the  furface  of  the 
digefted  matter  adhering  to  the  interline. 
Upon  removing  the  bile  from  the  furface  of 
this  digefted  matter,  it  did  not  appear  to  have 
mixed  with  it  in  any  fenfible  degree. 

3.  HENCE   it  feems   fomewhat  doubtful, 
whether    the    bile    really  forms  one  of  the 
conftituent  parts  of   the  chyle,    as  has  been 
imagined,     or  not.       If,    however,   all,    or 
any  of  the  elements  of  bile  do  contribute  to 
chylification,   no   traces    of  their  prefencc 
can  be  difcovered  from  the  fenftble  proper- 
ties of  the  chyle. 

4.  ANOTHER  difficulty  in  admitting  this 
as  one  ufe  of  the  bile,  is  from   the  circum- 
flances   of  jaundice.      In  *this  complaint, 
the  pafifage  of  that  fluid  into  the   inteftine 

I  2 


[      112      ] 

is  cither  completely  obflructed,  or  very 
much  impeded  -,  but  there  are  no  fymptoms 
which  clearly  manifeft  a  defect  of  chylifi- 
cation. 

5.  ONE  important  ufe  of  the  bile  is,  un- 
queftionably,   that  of  ftimulating  the  intef- 
tine,  and  performing  the  office  of  a  purga- 
tive -,   for  when  the  excretion  is  impeded,  as 
in  the  jaundice,  the   inteftines,    being  de- 
prived  of   their   natural  ftimulus,    become 
torpid,   and  coftivenefs  enfues. — This  torpor 
is  diffufed  by  fympathy  over   every   part   of 
the  fyftem,   and  languor  and  laffitude  pre- 
vail. 

6.  IT   is   probable,    therefore,   that  even 
admitting  the  bile   to  contribute  fomewhat 
to    the  digeftion    and     affimilation   of  our 
food  -,   its  principal  office  is  that  of  a  natu- 
ral and   habitual  ftimiilus  to   the  inteftines, 
keeping  up  their  energy  and  periftaltic  mo- 
tion, which  may  be  affected   either  by  an 


[     "3    1 

increafe  of  its  quantity,   or   a  change  in  its 
quality,    produced  by  difeafe. 

When  we  take,  however,  a  view  of  the 
conflituent  parts  of  bile,  as  clearly  afcer- 
tained  by  the  foregoing  chymical  experi- 
ments, it  feems  very  probable,  that  from 
its  refmous  bitter,  it  may  counteract  any 
active  and  fpontaneous  changes  to  which 
animal  and  vegetable  matter  would  other- 
wife  be  fubjectj  and  that  as  the  propenfity 
to  acidity  in  our  vegetable  aliment  is  ex- 
tremely obvious,  the  alkaline  matter  of 
bile  tends  to  correct  it.  Bilelikewife,  from 
its  faponaceous  and  foluble  quality,  lefTens 
the  adhefive  nature  of  our  foeces,  and,  by 
fmoothing  their  furface,  promotes  their  eva- 
cuation. In  cafes  of  defective  fecretion 
the  fceces  are  hard,  knotty,  and  irregularly 
fixed.  One  important  part  of  digeftion  is 
ultimately  perfected  in  the  upper  end  of 
the  duodenum $  and  as  perfect  digeilion  is 
always  oppofed  to  fermentable  changes, 
"i  3 


[     "4    ] 

the  bile  is  well  calculated  to  finifh  that  pro- 
cefs.  We  probably  may  err  in  confining 
the  ufe  of  bile,  therefore,  to  any  fingle 
operation,  while  from  its  nature  it  feems 
fo  well  qualified  to  anfwer  a  variety  of  ufe- 
ful  purpofes  in  the  animal  ceconomy.  We 
fhall  afterwards  obferve,  that  where  it  is  de- 
fective it  may  be  imitated  by  artificial 
means  with  advantage  ;  and  in  no  inftance 
has  the  application  of  chymiftry  to  the  cure 
of  difeafes  appeared  more  fuccefsful  than  in 
fuggefling  the  ufe  of  proper  remedies  in 
cafes  of  difeafed  and  defective  bile. 

It  frequently  occurs  that  bile  is  fecreted 
in  too  fmall  a  quantity,  as  in  hypochon- 
driacal  complaints,  and  chlorofis  -,  in  which 
difeafes  an  unufual  degree  of  torpor  takes 
place,  exprefled  in  the  one  cafe  by  dejection 
and  defpair ;  in  the  other  by  inactivity  and 
languor  ;  the  ftools  are  generally  of  a  light 
clay  colour,  and  the  body  is  coflive. 
Bile  therefore  affords  &  ftimulus  by  which 


[     "5    ]- 

tone  and  energy  are  communicated  from  the 
inteftines  to  the  whole  body,  the  defect  of 
which  on  the  primse  vias  is  more  productive 
of  difeafe  than  its  excefs.  In  the  latter 
cafe/  if  it  be  healthy  in  its  nature,  it  only 
proves  a  falutary  purgative,  but  if  in  a  dif- 
eafed  ftate,  it  deranges  the  animal  oecono- 
my  like  any  other  foreign  flimulus  which 
may  be  applied  to  the  inteftines. — It  like- 
wife,  from  its  bitternefs,  poffefles  antifeptic 
powers,  which  are  peculiarly  ufeful  in  the 
inteftinal  canal, 


[     "7    3 

OF  THE  DISEASES  OF  THE  LIVER 
DEPENDING  ON  ITS  FUNCTIONS  AS 
•     AN  ORGAN  OF  SECRETION. 


CHAP.    L 


ON  THE  INCREASED  SECRETION 
OF  BILE. 


SECT.   I. 

Jl  H  E  Inhabitants  of  warm  climates  are 
extremely  fubjecl  to  difeafes  arifing  from 
the  increafed  fecretion  of  bile,  and  the 
excefs'  of  its  quantity  in  the  primas  via?, 
which,  either  by  regurgitating  into  the  fto- 
mach,  produces  a  general  languor  of  the 
body,  together  with  naufea>  foul  tongue^ 


[     "8    ] 

lofs  of  appetite,  and  indigeftion  j  or,  by 
being  directed  to  the  inteftines,  excites  a 
painful  diarrhoea,  ultimately  tending  to 
weaken  their  tone,  and  diflurb  theif  regular 
perifbaltic  motion.  It  generally  happens 
that,  during  the  excefs  and  prevalence  of 
bile  in  the  firft  pafiages,  fome  abforption 
of  it  takes  place  in  the  habit,  fo  that  the  fkin 
becomes  yellow,  and  the  urine  is  fenfibly  im- 
pregnated with  it.  The  pulfe  is  quicker 
than  natural,  and  there  is  a  confiderable  de- 
gree of  third,  with  an  increafe  of  heat,  the 
ufual  fymptoms  of  fever.  The  body  be- 
comes emaciated,  and  the  general  afpect 
of  the  patient  is  extremely  unhealthy. 

2.  Under  fuch  circumftances,  a  change 
of  climate  becomes  neceflary,  by  which  the 
fecretion  of  bile  is  gradually  diminifhed, 
its  powers,  perhaps,  rendered  lefs  active, 
and  the  healthy  functions  of  the  flomach 
and  bowels  are  again  reftored.  A  fea 
yoyage  from  a  warm  to  a  colder  clim  ate 


[     "9    1 

generally  efFeds  this  purpofe,  fuppofmg,  as 
is  frequently  the  cafe,  that  the  liver  and 
and  other  abdominal  vifcera  are  in  a  found 
ftate.  ^ 

3.  SUCH  fymptoms  as  I  have  now  enu- 
merated are  the  fpontaneous  effects  of  a 
warm  climate  on  healthy  conftitutions,  inde- 
pendent of  any  intemperance,  and  cannot 
always  be  prevented  by  the  moft  careful 
attention  to  diet,  or  by  avoiding  fuch  irre- 
gularities as,  in  all  fituations,  contribute  to 
produce  difeafe. 

4.  THE  natives  of  warm  climates  are  lefs 
fubjecl  to  the  inconveniences  arifing  from 
the  increafed  fecretion  of  bile   than  Euro- 
peans   who   inhabit   thofe    countries,    and 
whofe  conftitution,   by  former  habits,  is  ill 
prepared  to  admit  fuch  increafed  excitement 
of  the  liver,  or  fuch  additional  irritation  on 
the  primse  vise,  without  much  derangement 
of    the  *  animal   reconomy.      The   bile    in 
•warm  Slimates  is,  perhaps,  more  bitter  and 


[      120     ] 

more  faturated  with  its  component  part* 
than  in  colder  countries  ;  it  is  therefore  a 
more  adttve  emetic  or  purgative  -,  and,  al- 
though it  was  not  fecreted  in  a  larger  quan- 
tity, its  effects  on  the  firft  pafTages  would  be 
more  feverely  felt. 

5.  WE  have  had  occafion,  in  treating  of 
the  nature  and  properties  of  bile,  to  correct 
a  common  and  prevailing  opinion  of  its  be- 
ing extremely  putrefcent  -,  experiments,  ex- 
ecuted with  great  accuracy  and  fidelity, 
fufEciently  prove  that  it  is  lefs  difpofed  to 
putrify  than  any  other  animal  fluid  ;  -and 
that  it  even  preferves,  in  a  fweet  flate,  ani- 
mal fubflances,  which,  when  expofed  to 
limilar  circumftances  of  fluidity  and  heat, 
without  the  admixture  of  bile,  would  in  "a 
Ihorter  time  have  aflumed  the  character  of 
putrefaction.  It  feems,  therefore,  to  be  a 
wife  law  of  the  animal  ceconomy,  that  in 
warm  climates  a  larger  quantity  of  this 
fluid  fhould  be  prepared  by  the  conuitution 


[      121      ] 

than  in  colder  countries  -9  and  by  its  being 
more  bitter  and  more  active,  it  pofiefTes  a 
greater  antifeptic  power  than  the  milder  and 
more  diluted  fluid  of  a  colder  climate ; 
hence  it  is  better  fitted  to  correct  and  re- 
flrain  the  propenfities  to  fpontaneous  and 
putrid  fermentations,  fo  extremely  preva- 
lent in  warm  climates. 

6.  I  DO  not,  however,  mean  to  deny,  that 
many  and  great  inconveniences  are  found  to 
arife  from  the  prevalence  of  bile  in  the 
primse  vise  ;  but  I  am  firmly  perfuaded, 
that  a  diminution  of  its  natural  quantity 
would  produce  difeafes  of  a  more  permanent 
and  alarming  nature.  It  is  more  difficult  to 
fupply  the  defect  in  the  quantity  of  this  fluid, 
than  to  carry  off  its  excefs ;  it  is  even  more 
eafy.  to  diminifti  its  acrimony  than  to  in- 
creafe  its  power,  and  thereby  render  it  more 
active,  and  better  fuited  to  anfwer  the  vari- 
ous and  ufeful  purpofes  intended  by  it  to  the 
animal  ceconomy. 

M 


7.  I  HAVE  been  frequently  confulted  by 
perfons  whofe  appetite  and  digeftion  have 
been  much  diflurbed  by  a  long  refidence  in 
tropical  climates  ;    and  who,  although  they 
have  generally  received  much  benefit  by  a 
fea  voyage,  and  a  gradual  return  to  Europe, 
yet  require  the  afliflance  of  medicine,  with 
a  view  to  deftroy  the  tendency  to  exceflive 
fecretion,  and  finally  to  reftore  ftrength  and 
vigorous -action. 

8.  AFTEP.  obtaining  all  the  information 
which  I  fuppofe  neceftary  refpecling  the  con- 
flitution  and  habits  of  the  patient,  the  ori- 
ginal   and   progreffive   ftate  of  fymptoms, 
and  the  effects  of  fuch  remedies  as  have  been 
employed,  I  proceed  to  afcertain  how  far 
any  local  or  organic  affection  of  any  of  the 
vifcera  has  taken  place. — If,  upon  inveftiga- 
tion,  I  find  that  the  conftitution  has  only 
iuffered  by  the  prevalence  or  the  excefs  of 
bile,   and  that  the  difpofition  to  that  morbid 
incrcafe  of  fecretion  flill  remains,   difturb^ 


[     «3    3 

ing  the  functions  of  the  ftomach,  and  irri- 
tating the  bowels,  I  recommend  it  to  my 
patient,  every  morning  before  breakfaft,  to 
dilute  the  contents  of  the  flomach,  by 
drinking  from  half  a  pint  to  a  pint  of  water, 
of  a  temperature  from  90  to  1 14  degrees  of 
Farrenheit's  thermometer,  likewife  to  'take 
a  moderate  degree  of  exercife  before  break- 
fad.  This  may  be  done  either  in  London  or 
at  Bath,  though  I  am  perfuaded,  that  the  be- 
nefit derived  is  by  dilution,  and  that  tepid 

<?? 

water  dilutes  better  than  cold  water,  and 
that  pure  water  dilutes  better  than  water 
impregnated  with  faline,  earthy,  or  metallic 
matter. — I  do  not,  however,  mean  to  dif- 
courage  invalids  from  going  to  places  of 
public  refort,  which  may  contribute,  by 
their  amufements,  to  reftore  a  conftitution 
enfeebled  by  a  warm  climate,  or  intenfe  ap- 
plication to  bufinefs. 

9.    THE    chymical    analyfis   of    mineral 
waters  has  been  of  confiderable  advantage, 
M  2 


fince,  befides  the  difcoveries  which  it  has 
made  with  refpedt  to  the  folid  contents  of 
many  of  them,  it  has  alfo  proved,  with  re- 
fped  toothers,  which  contain  but  little  folid 
matter,  that  it  is  the  quantity  of  water,  and 
not  the  impregnating  fubftance,  which  does 
good. 

I  believe  the  experiment  of  drinking  good 
pump  water  at  home,  of  the  temperature  of 
Bath,  Buxton,  or  Briftol  water,  has  feldom 
been  tried.  I  have  frequently,  with  much 
fuccefs,  recommended  the  ufe  of  warm  wa- 
ter in  dyfpeptic  cafes  f*  and  in  anomalous 
gout,  it  feems  to  allay  the  irritation  of  the 
flomacfc,  to  promote  and  difFufe  a  generous 
warmth  in  the  extreme  parts,  and,  if  taken 
at  night,  will  generally  produce  fleep.  Per- 
haps it  acts  upon  the  principle  of  tepid 
bathing  ;  with- .  this  difference,  that  any 
action  on-  the  ftomach  has  a  more  extenfive 
influence  on  the  fyilem,  than  the  fame  action 
would  have  on  the  furface  of  the  body. 


to.  WATER  heated  to  a  certain  degree, 
when  taken  into  the  llomach  will  produce 
giddinefs  of  the  head,  while  the  fame  water, 
of  a  lower  temperature,  will  produce  no 
fuch  effect  :  this  is  the  reafon  why  patients 
at  Bath  are  dire&ed  to  drink  the  water  of 
different  fprings,  though  not  differently  im- 
pregnated, and  it  gives  rife  to  a  refinement 
in  practice  which  has  for  its  foundation  only 
the  different  effects  of  temperature.  It  is 
not  improbable,  but  that  more  benefit  will 
arife  when  the  temperature  is  carried  to  that 
degree  which  produces  fome  fenfible  effect 
upon  the  head  ;  it  is  impoffible  to  lay  down 
any  general  rule  on  this  fubject  j  it  is  trial 
alone  on  the  individual  that  can  determine 
the  point  of  action. 

ii.  I  CONSIDER*  the  waters  of  Bach,  Brif- 
tol,  and  Buxton,  as  not  having  any  powers 
fuperior  to  common  pump  water,  heated  to 
the  fame  temperature.  The  fteadinefs  and 
uniformity,  however,  of  their  feveral  tem- 
M  3 


L    126    ] 

peratnres  entitle  them  to  fome  preference, 
and  render  them  proper  to  be  drunk  by  per- 
fons  whofe  ftomachs  are  irritable,  and  im- 
patient of  their  contents,  and  perhaps  weak- 
ened in  their  digeftive  powers  by  long  habits 
of  ingurgitation  and  gluttony,  or  from  in- 
tenfe  application  to  ftudy,  accompanied  with 
a  fedentary  life. 

12.  IN  fick  headachs,  which  generally 
arife  from  bile  in  the  flomach,  half  a  pint 
of  warm  water  taken  at  bed  time  has  a  good 
effect.  In  all  cafes  where  bile  is  fecreted  in 
too  large  a  quantity,  the  ufe  of  emetics  is 
improper  ;  they  increafe  the  irritable  condi- 
tion of  the  hepatic  fyftem,  and  divert  the 
bile  from  the  inteflines.  In  almoft  all  cafes 
where  vomits  are  given,  bile,  during  their 
action,  is  forced  from  the  duodenum  into  the 
flomach,  which  would  otherwife  have  been 
carried  off  by  the  inteflines  ;  indeed,  the 
actions  of  naufea  and  vomiting  increafe  its 
fecretion.  In  general,  bile  is  a  purgative 


t  127  ] 

• 

fufliciently  ftimiilating  for  its  own  evacuati- 
on, only  requiring  the  afliftance  of  warm 
water  for  facilitating  its  difcharge  :  if,  how- 
ever, in  fome  cafes,  it  irritates  without 
purging,  I  would  recommend  the  ufe  of 
fmall  dofes  of  the  neutral  falts,  fuch  as  folu- 
ble  tartar,  fal  catharticus  amarus,  and  the 
like  ;  and  in  all  cafes  they  do  mofb  good  un- 
der dilution. 

13.  THIS  fuggefts  the  propriety  of  re- 
commending the  ufe  of  Cheltenham  water 
to  perfons  returning  from  warm  climates* 
It  may  be  drank  either  with  or  .without  its 
chalybeate  part,  but  at  all  events  its  dofe 
fhould  be  fuch  as  to  produce  a  purgative 
"effect.  Perhaps  it  would  be  more  advan- 
tageous to  take  it  every  other  morning  than 
to  ufe  it  daily  :  it  may  be  fuccefsfuily  and 
•  well  imitated  by  artificial  means,  fo  as  to 
be  drunk  at  a  diftance  from  the  fpring  near- 
ly with  equal  effect  as  at  Cheltenham. 

14..  THE  flomach.,  in  its  energy  and  pow- 


r  128 

• 

er,  is  greatly  aflifted  by  warm  clothing,   ef* 
pccially  on  the  lower  extremities  of  the  bo- 
dy.    The  diet  of  a  patient,  whofe  ftomach 
and  bowels  are  extremely  irritable  by   the 
excefs   and    prevalence  of  bile,    Ihould  be 
moderate  in  quantity,  and  of  eafy  digeftion. 
This  will  necelTarily  exclude  melted  butter, 
every  thing  fried,    every  fpecies  of  paftry, 
together  with  cold,  and  raw  or  unboiled  ve- 
getables.    Ripe  fruits  may  be  admitted,  in 
moderate  quantities,   rather  before  than  af- 
ter dinner.      Water,  or   wine   and  water, 
may  be  drank  for  common  ufe.     Spirituous 
liquors  of  all  kinds  fhould  be  avoided,  as 
having  a  tendency,  more  diredly,   to  pro- 
duce difeafes  of  the  liver,     and  to  weaken 
the  tone  of  the  ftomach. 

15.  THE  CHOLERA  MORBUS  may  very 
properly  be  confidered  under  the  head  of 
thofe  difeafes  which  depend  on  the  increafed 
fecretion  of  bile.  It  takes  place,  with  dif- 
ferent degrees  of  violence,  in  different  ha- 


bits  :  in  fome  it  is  fo  acute  as  to  prove  fatal 
in  a  few  hours,  while  in  others  it  is  expreffed 
only  by  a  flight  purgative  and  emetic  ope- 
ration. In  general  the  fymptoms  are  as 
follow. 

1 6.  THE  patient  is  feized  with  a  violent 
difcharge  of  a  dark  coloured  fluid,  in  large 
quantity,  and  fome  what   of  a  bitter  tafte, 
both  from  the  ftomach  and  inteftines,  with 
much  pain  and  anxiety  about  the  prxcordia, 

I  together  with  cramps  or  fpafms,  particular- 
ly of  the  lower  extremities  ;  there  is  a  con- 
fiderable  degree  of  thirft,  the  pulfe  is  ex- 
tremely quick  and  weak*  When  the  difeafe 
proves  fatal,  the  pulfe  intermits  and  becomes 
more  feeble,  the  extremities  become  cold, 
the  patient  is  feized  with  hiccup,  and  dies 
in  the  fame  manner  as  perfons  do  from  in- 
flammation of  the  bowels. 

17.  THIS  difeafe   is   extremely  prevalent 
in  this   country,  in   the  months  of  Augufl: 
and  September,  fo  as  to  be  confidcred  as 


f 

an  autumnal  epidemic.  It  frequently  takes 
place  fpontaneoufly,  and  independently  of 
any  fenfible  occafional  caufe  being  applied ; 
at  other  times  it  is  evidently  connecled  with 
a  fudden  change  of  temperature  in  thofe 
months. 

1 8  IT  may  likewife  arife  from  the  in- 
temperate ufe  of  food  of  difficult  digeftion, 
and  unripe  fruits.  In  the  autumn,  the  he- 
patic fyftem  is  more  irritable  in  this  country, 
than  at  any  other  feafon  :  and  the  difeafes, 
which  prevail  in  the  months  of  Augufl  and 
September,  are  obvioufly  connecled  with 
the  flate  of  the  biliary  fecretion,  and  ap- 
proach in  their  nature  to  fuch  as  prevail  in 
warm  climates. 

19.  THE  fluid  difcharged   in  the  Cholera 
Morlus  is  evidently  bilious,    but  it  is  bile  in 
a  very  difeafed  flate,  by  no  means  correfpond- 
iiig  with  the  character   of  the   natural  or 
healthy  flate  of  that  fluid. 

20.  IT  feems    probable,  that   from  the 


C     '3t     1 

quantity  fecreted,  and  the  rapid  manner  in 
which  it  is  poured  into  the  duodenum, 
there  is  not  time  fufficient  for  a  perfect  fe- 
cretion,  that  the  fluid  therefore  is  fome- 
what  of  an  intermediate  nature  between 
blood  and  bile.  Perhaps,  from  a  hurried 
circulation,  a  confiderable  quantity  of  red 
globules  efcape,  unchanged,  from  the  ca- 
pillary vefTels  into  the. port  biliarii,  and  unit- 
ing with  a  portion  of  bile,  are  carried  by  the 
hepatic  duels  into  the  duodenum. 

21.  THE  varied  and  increafed  action  of  a 
gland  has  much  influence   in  determining 
the  nature  of  the  fluid  fecreted.     In   fome 
cafes  bile  is  difcharged,  of  a  green  colour, 
and  extremely  acrid,  not  pofTefllng  the  qua- 
lities of  healthy  bile. 

22.  THE  cure  of  Cholera,  Morbus  is  bed 
effected,  by  firft  diluting  the  contents  of  the 
ftomach  and  inteftines,    by  the  plentiful  ufe 
of  warm  water,  water  gruel,  chicken  broth, 
and  the  like,  and  afterwards    by  allaying 


C      '32      ] 

irritation  by  opiates.  In  the  advanced  ftage 
of  the  difeafe,  with  a  weak  pulfe  and  cold 
extremities,  I  have  feen  great  advantage 
from  the  ufe  of  opium  with  aromatics,  as  in 
the  confettio  opiata,  and  of  mufk  in  large 
dofes.  Every  thing  which  has  a  tendency 
to  vomit  or  purge  actively  Ihould  be  avoid- 
ed, but  emollient  glyfters  may  be  frequently 
employed.  If,  in  the  firit  flage  of  the  dif- 
eafe,  fymptoms  of  fever  and  inflammation 
fhould  occur,  the  patient  may  lofe  a  confi- 
derable  quantity  of  blood,  and  a  large  blifter 
.fhould  be  applied  to  the  abdomen.  In  fome 
cafes  the  warm  bath  may  be  employed  with 
advantage ;  it  is,  however,  chiefly  to  diluents 
and  opiates  that  we  truft  for  a  cure. 

23.  THE  fecretion  of  bile  is  frequently 
increafed  and  hurried  by  caufes  ading  on 
the  ftomach,  fuch  as  fea  ficknefs,  and  eme- 
tics 5  the  difcharge  of  bile  by  vomiting  is, 
therefore,  no  proof  of  its  having  exifted  in 
the  ftomach  before  the  exhibition  of  the  vo- 


[     133    ] 

•mit,  or  of  its  having  been  the  primary  caufe 
of  naufea  and  indigeftion  :  it  is  only  the 
effect  of  direct  a6tion  on  that  organ. 

24.  IN    the   bilious  fever   of   the   Weft 
Indies,   the   naufea    and   vomiting,    which 
arife  from  fome  flight  degree  of  inflammati- 
on near  the  pylorus  and  upper  furface  of  the 
duodenum,    invite  bile  into   the   ftomach, 
which    has    no    tendency   to    produce  the 
fever;  it  is  only  an  effect,  and  not  the  caufe 
of  the  difeafe. 

25.  IN  warm  climates,    contagious  and 
febrile  poiibns  have  a  great  tendency  to  act 
on  the  hepatic  fyftem,   and  hurry  much  the 
fecretion  of  bile  ;  indeed,  hemorrhages  from 
the  liver,  accompanying  the  increafed  fecre- 
tion of  bile,  frequently  take  place,  and  dif- 
fection    generally  Ihows    congeftion  and  a 
turgefcent  ftate  of  that  organ ;  this  naturally 
fuggefts  the  ufe  of  active  purgatives  in  thofe 
fevers,  fuch  as  calomel,  jalap,  and  the  neu- 
tral falts  j    indeed,  fo  fpecifkally  has   the 


C   134  ] 

liver  been  fuppofed  affe&ed  in  thefe  cafes, 
that  fome  late  writers  on  the  fubject  of  the 
contagious  yellow  fever  now  raging  in  the 
Weft  Indies,  have  recommended  the  ufe  of 
mercury,  in  order  to  produce  a  falivation  5 
under  which,  we  are  allured,  all  the  fymp~ 
toms  of  malignancy  have  fubfided. 


[     135     3 


CHAP.    II. 


OF  THE  DIMINISHED  SECRETION 
OF  BILE. 


S  E  C  T.    I. 

JLR  o  M  what  has  been  already  obferved 
on  the  ufe  of  bile  and  its  application  to  the, 
purpofes  of  the  animal  cecoaomy,  it  is  ob- 
vious, that  a  confiderable  diminution  of  the 
quantity  fccreted  will  be  followed  by  difeafe. 
The  liver  may  be  rendered  incapable  of 
fecreting  the  ufual  quantity  of  bile  by  any 
defedt  in  its  ftrudure ;  and  that  this  is,  fre- 

N   2 


C/36    ] 

quently,  the  impeding  caufe,  appears  from 
direction. 

2.  IT  is  an  organ  very  fufceptible  of 
chronic  inflammation,  which,  without 
alarming  in  the  firfl  inftance,  by  painful  or 
active  fymptorns,  gradually  induces  obftruc- 
tion  -9  firft,  with  an  increafe,  and  frequently 
afterwards  a  diminution  of  its  bulk,  perhaps 
ultimately  obliterating  the  capillary  fyftem 
and  pori  biliarii,  the  more  immediate  feat 
of  fecretion.  In  fuch  cafes,  the  patient  will 
be  fubject  to  occafional  pain  in  the  right 
hypochondrium,  extending  to  the  fcapulse,  a 
quick  pulfe,  an  increafe  of  heat,  alternating 
with  chilly  fenfations,  difficult  breathing  on 
quick  motion,  fome  difficulty  on  lying  on 
the  left  fide,  flatulency,  indigeftion,  acidity, 
coftivenefs,  and,  together  with  a  gradual 
diminution  of  ftrength  and  fleih,  the  patient 
has  a  pale  or  fallow  complexion.  Such 
fymptoms  are  accompanied  with  a  defecl: 
in  the  fecretion  of  bile,  and  a  torpid  ftate 
of  the  inteitines. 


[     137    ] 

3.  IT  is  probable,  that  under  thefe  cir- 
cumftances,  the  original  mifchief  is  in  the 
ftomach  and  duodenum,  and  that  the  fym- 
pathetic  action  on  the  liver  is  lefs,  on  which 
perhaps  healthy  fecretion  may  depend  ; 
hence  dyfpepti'c  complaints  generally  pre- 
cede affections  of  the  liver,  and  arife  from 
intemperance  either  in  eating  or  drinking, 
but  are  more  particularly  induced  by  the 
abufe  of  fpiricuous  liquors,  even  though 
diluted  with  water.  The  flomach,  by  long 
failing,  has  its  digeftive  powers  much  weak- 
ened, by  which  the  fecretion  of  bile  is  dimi- 
nifhed,  and  a  difeafed  ftru6ture  of  the  organ 
ultimately  induced.  Grief  and  anxiety  of 
mind  firft  weaken  the  powers  of  the  ftomach, 
and  ultimately  thofe  of  the  liver,  and  there- 
by diminilh  fecretion  :  a  fedentary  life  will 
do  the  fame.  • 

4.  HYPOCHONDRIACAL  complaints  are  al- 
ways attended  with  fymptoms  of  dyfpepfia 
and  diminifhed  fecretion,  and  great  torpor  of 


the  alimentary  canal.  In  the  chlorofis  of 
women  we  have  likewife  a  diminution  in  the 
quantity  and  adlivity  of  bile. 

5.  WHEN. the    diminifhed    fecretion    is 
preceded  by  affe&ions  of  the  (lomach,  fuch 
as  lofs  of  appetite,    indigeftion,   and  flatu- 
lent  eru&ations,    the    diet   of  the  patient 
fhould   be  attentively   regulated  $    and    the 
art  of  cookery  fhould  be  rendered   merely 
fubfervient  to  digeftion,    and   the   prepara- 
tion of  healthy  chyle.    The  quantity  of  food 
taken  at  any  one  time  fhould  be   moderate, 
and  water  fhould  be  the  only  liquid  drunk 
with  our  meals,   as  more   effectually    pro- 
moting digeftion  than  fermented  liquors  of 
any  kind.     All  raw  or  unboiled  vegetables 
fhould  be  avoided  ;   ripe  fruits  may  be   mo- 
derately taken  ;   almoft  all  boiled  vegetables 
may  be  admitted.     Animal  food  fhould    be 
well  boiled,    or    moderately    roafted,     and 
taken  with  its  own  gravy.     Pye-cruft,   and 
every  thing  fried,  fhould  be  excluded  3  but- 


[     '39    ] 

ter,  rendered  rancid  by  being  melted, 
ihould  be  likewife  forbid.  The  patient 
fhould  ufe  moderate  exercife,  and  drink 
fome  natural  chalybeate  water  of  a  tepid 
heat,  before  breakfaft,  and  perhaps  in  the 
evening.  By  thus  giving  vigour  and  energy 
to  the  ftomach  and  duodenum,  the  healthy 
action  of  the  liver  will  be  reflored. 

6.  I  am  perfuaded  that  the  ftomach  digefts' 
folid  aliment  more  eafily  than  liquid  and 
bulky  food ;  and  that  foups  and  broths  are 
more  quickly  difpofed  to  run  into  active 
fermentation,  and  require  the  exertion  of 
more  vitality  to  reftrain  fuch  morbid  and 
fpontaneous  changes,  than  animal  food  in 
a  folid  form.  During  the  period  of  our 
being  awake,  the  ftomach  fhould  have  a 
fupply  of  food,  at  leaft  every  fix  hours ; 
the  quantity,  in  that  cafe,  would  be  more 
moderate  at  any  one  time,  and  would  be  pro- 
portioned to  the  demand  of  the  fyftem  : 
the  fupply  Ihould  be  regular.  Nor  is  there 


t    HO     ] 

1* 

any  good  foundation  for  diverfifying  our 
meals  j  fo  that  breakfaft  and  dinner  ihould 
be  made  up  of  different  kinds  of  food. 
The  fecretion  of  bile  would  be  thereby  more 
regular,  and  the  quality  better  prefervcd 
under  fuch  a  regimen.  A  ftomach,  vitiat- 
ed by  bad  habits,  is  widi  difficulty  reformed, 
but  may  ultimately  be  reconciled  to  fnnple 
and  healthy  aliment.  There  are  fome  flo- 
machs  which  reject  milk  when  it  has  been 
medicinally  recommended  ;  but  they  arc 
fuch  to  which  milk  has  been  a  perfect  ftran- 
ger  j  and  in  that,  as  in  fimilar  cafes,  fmall 
repeated  quantities  of  it,  taken  without 
the  mixture  of  any  other  kind  of  food, 
have  reconciled  the  flomach  to  any  larger 
quantity,  which  may  be  thought. necefTary. 
The  condition  of  the  gaftric  fluid,  and  the 
action  of  the  ftomach,  accommodate  them- 
felves  to  that  regimen,  to  which  the  ilornach 
has  been  accuflomed. 

7.  TH£RE  are  fome  ilomachs  which  are 


quick  and  powerful  in  finifhing  the  procefs 
of  digeftion,  and  may  require  a  greater  and 
more  frequent  fupply  of  aliment  than 
others,  whofe  powers  are  more  limited ; 
but  in  all  cafes  the  ftomach  fhould  never  be 
perfectly  empty.  A  fenfe  of  uneafinefs  and 
acute  pain  has  proceeded  from  mere  empti- 
nefs,  under  which,  perhaps,  the  ftomach 
may  be  faid  to  feed  upon  itfelf :  this  occurs 
very  frequently  in  delicate  females  j  who, 
^either  from  caprice  or  fafhion,  take  in  very 
fmall  quantities  of  food  at  any  one  time, 
and  yet  whofe  meals  are  not  more  frequent 
than  others  of  a  more  vigorous  conftitution. 
In  fuch  cafes  a  meat  breakfaft,  and  a  lunche- 
on at  noon,  will  prove  the  beft  remedies. 
I  believe  that  chlorofis,  atrophy,  tubercle, 
and  other  glandular  affections,  would  be 
beft  obviated  by  fuch  a  regimen,  and  females 
acquire  more  vigorous  and  active  health  by 
fuch  a  plan  as  is  now  recommended.  With 
refpect  to  the  quality  of  our  different  meals, 


] 

we  feem  to  depart  more  from  the  cuftom 
of  our  hardy  anceilors,  with  regard  to  break- 
fall,  than  any  other  meaL* 

A  very  leading  fymptom  of  a  '-weak  flo- 
mach,  and  an  enervated  conftitution,  is  the 
loathing  of  food  at  breakfaft ;  while  a  vigor- 
ous ftomach  difcovers  more  energy  in  the 
morning  than  at  any  other  time  of  the  day. 
Digeflion  is  beft  promoted  by  a  flate  of  reft 
after  eating,  and  the  exercife  of  the  body  is 
beft  adapted  to  reftpfirig  energy,  and  pro- 
moting the  necefTary  fecretions.f 

*  A  Maid  of  Honor,  at  the  Court  of  Queen 
Elizabeth,  breakfafted  upon  beef,  and  drank  ale 
after  it ; — while  the  Sportfman,  and  even  the  Day- 
labourer,  now  frequently  breakfaft  upon  tea. 

f  Dr.  Harwood,  the  Profeflbr  of  Anatomy  at 
Cambridge,  took  two  pointers  equally  hungry, 
and  equally  well  fed  ;  the  one  he  fuffered  to  lie 
quiet  after  his  meal,  and  the  other  he'kept  for 
above  two  hours  in  conftant  exercife.  On  re- 
turning home,  he  had  them  both  killed.  In  the 
ftomach  of  the  dog  that  was  quiet,  and  afleep,  all 
the  food  was  digefted  :  but  ia  the  ftomach  of  the 
other  dog  that  piocefs  was  fcarcely  begun. 


.  [     143    ] 

6.  The  temporary  lofs  of  bile  may  be 
fupplied  by  various  bitters,  occafionally 
united  with  rhubarb,  aloes,  and  the  like. 
The  excefs  of  acidity  may  be  corrected  by 
alkaline  remedies  and  lime  water.  In  in- 
fants the  bile  is  frequently  not  fufEciently 
active,  and  generally  fecreted  in  too  fmall  a 
quantity,  which  in  them  induces  difeafes  of 
prevailing  acidity.* 

r  We  may  obferve  farther,  that  the  ftomach, 
in  its  office  of  digeftion,  may  derive  affiftance  from 
the  liver,  by  the  latter  counteracting  fome  of  thofe 
effects  which  arife  from  the  difeafed  action  of  the 
former/ 

We  know  that  when  the  powers  of  the  ftomach 
have  been  weakened,  and  when  the  digeftive  pro- 
cefs  confequently  proceeds  but  flowly  and  weakly, 
there  is  often  a  confiderable  tendency  to  acefcency 
in  the  different  parts  of  the  primse  vise.  Differ- 
ent portions  of  the  aliment,  taken  in,  have  a  ten- 
dency to  run  into  the  acetous  fermentation,  when 
affifted  by  heat  and  moifture. 

Thus  we  find  many  of  the  vegetables  which  we 
take  into  our  ftomachs,  are  digefted  with  difficulty, 
and  are  very  apt,  in  bad  ftomachs,  to  occafiou 
fymptoms  of  acidity.  Flatulence  and  diftention 
frequently  fucceed  the  taking  of  thefe  fubftances 


[     144    ]• 

7.  IN  cafes  of  difeafed  ftrudlure  of  the 
liver,  producing  a  diminution  of  fecretion, 
and  particularly  when  fuch  change  of  flruc- 

into  the  ftomach,  and  the  gaffes  fent  out  from  the 
mouth  ferve  as  an  indication  of  what  is  going  for- 
ward within.  Cabbages,  cauliflowers,  peas,  beans, 
and  the  different  farinaceous  vegetables,  are  apt  to 
produce  this  effect  ;  whilft  thole  fubftances  which 
have  no  direct  tendency  to  acefcency,  may  yet 
prove  an  indirect  caufe  of  it,  by  weakening  the 
tone  of  the  ftomach,  and  thus  difturbing  the  di- 
geftive  and  afilmilating  functions. 

But  there  feems  to  be  a  power  in  a  healthy  fto- 
mach of  counteracting  thofe  fpontaneous  changes 
^vhich  would  take  place  out  of  the  ftomach,  or  in 
a  difeafed  ftomach.  It  is  not,  perhaps,  too  much 
to  expect,  from  a  vigorous  ftomach,  that  it  fhould 
convert  into  good  nutriment,  every  thing  which 
contains  materials  capable  of  forming  a  healthy 
chyle.  Its  powers  may  probably  extend  much 
farther  than  any  trial  yet  made  has  difcovered  ; 
and  many  fubftances,  which  cuftom  has  not  yet 
introduced  as  articles  of  diet,  may  be  very  well 
managed  by  this  organ.  We  find  that  it  is  capa- 
ble of  affimilating  fome  fubftances  which  are  vari- 
ous and  heterogeneous,  and,  therefore,  it  is  fa/r 
to  conclude,  that  it  is  equally  capable  of  acting 
upon  fome  which  are  more  fimple. 


t     145    ] 

ture  has  arifen  from  inflammation,  mercury 
has  been  found  ufeful,   even  carried  to   the 

degree   of    producing    a   flight   falivation, 

• 
If,  then,  the  ftomach  poiTeiTes  a  power,  when 

in  a  healthy  ftate,  of  counteracting  the  fpontane- 
ous  changes  which  would  take  place  in  fome  fub- 
.ftances  out  of  the  body,  and  will  even  prevent 
acefcency  in  thofe  which  are  difpofed  to  produce 
it,  if  acefcency  does  prevail,  we  muft  conclude, 
that  it  is  owing  to  fome  diminution  of  the  powers 
of  the  flomach.  The  queftion  then  to  be  anfvver- 
ed  is,  "  Can  the  liver  contribute  any  thing  to- 
**  wards  the  prevp  .*  of  fuch  an  effect  as  this  ?" 

It  has  bee  /  proved,  in  the  courfe  of 

thofe  expt. ,.  -  v.-hich  have  been  before  related, 
that  there  is  L*  Ji.e  a  refinous  fubftance,  in  which 
refide  the  colouring  principle  and  bitter  tafte. 
This  bitter,  refembling  the  vegetable  bitter,  has 
probably  properties  in  common  with  that,  and  is 
capable  of  refitting  the  fermentation  going  on  in 
the  ftomach,  and  alimentary  canal,  when  any  of 
its  contents  are  difpofed  to  run  into  this  ftate. 
When  it  cames  into  contact  with  thefe  fubRances, 
it  may  act  as  a  chymical  agent,  and  produce  fuch 
a  change  upon  them  as  fhall  prevent  that  procefs 
to  which  they  are  difpofeJ. 

That  this  is  the  effect  of  the  vegetable  bitter  on 
other  occasions,  conitant  experience  evinces,  in 
o 


moderating  the  violence,   however,  of  its 
operation   by  plentiful  dilution   with  gum 

arabic,  and  other  vegetable  demulcents. 

• 

the  ufe  of  hops,  by  which  beer  is  prevented  from 
proceeding  fo  rapidly  to  the  acetous  fermentation. 

The  alkali,  which  is  discovered  as  a  conftituent 
part  of  the  bile,  may  ferve  to  neutralize  the  acef- 
cent  matter  when  it  prevails  in  too  high  a  degree, 
and  thus  prevent  any  mifchievous  effects,  which 
might  arife  from  its  continuance  in  that  ftate, 
during  its  paUage  through  other  parts  of  the  fyf- 
tem.  We  are  to  remember,  that  if  this  change 
does  not  take  place  till  after  it  has  pafTed  from 
the  ftomach  into  the  duodenum,  it  may  ftill,  in  a 
fecondary  way,  operate  upon  the  ftomach,  upon 
that  principle  of  fympathy  which  we  have  before 
referred  to,  as  fubfifting  between  different  parts  of 
the  alimentary  canal,  or  between  the  ftomach  and 
duodenum,  or  other  fmall  inteftines. 

Let  us  pbferve  farther,  that  the  mineral  alkali 
which  conftitutes  a  part  of  healthy  bile,  may  ferve 
to  neutralize  the  acefcent  matter  when  it  prevails 
in  too  high  a  degree,  and  fo  prevent  any  mifchiev- 
ous effects  which  might  arife  from  its  continuance 
in  that  ftate,  whilft  it  is  pafBng  through  other 
parts  of  the  fyftem. 

But  not  only  to  this  acefcent  ftate  of  the  con- 
tents of  the  primae  vise,  but  alfo  to  that  of  putref- 


[     147    ] 

In  many  cafes  where  the  liver  and  other 
abdominal  vifcera  have  been  difeafed,  and 
in  cafes  of  glandular  and  mefenteric  affec- 
tion, attended  with  pain  and  tenfion,  and 
even  fymptoms  of  hectic  fever,  I  have 
feen  advantages  from  tepid  bathing,  th<: 
temperature  of  the  water  being  90  degrees 
of  Farenhek's  thermometer.  The  practice 
of  tepid  bathing  may  accompany  the  uie 
of  mercury,  and  may  moderate  the  dan- 

cency>  the  bile  offers  a  proper  corrective.  The 
foregoing  experiments  ferve  to  prove  the  greater 
power  which  bile  has  of  refitting  putrefaction  than 
the  blood.  Without  referring,  at  prefent,  to  the 
relative difpofition  to  putrefcency  betwixt  the  two 
fluids,  we  may  real  ark,  that  if  the  bitter  property 
of  bile  have  this  tendency,  this  is  a  circumllance 
which  at  once  explains  the  effect  referred  to.  But 
when  we  confider  that  to  preferve  the  general  tone 
and  vigour  of  thefyftem  is  the  heft  mode  of  obvi- 
ating putrefcency,  we  may  attribute  this  effect  to 
the  bile,  which,  by  its  immediate  influence  on  the 
inteftine,  and  its  more  remote  influence  on  the  ge- 
neral fyftem,  through  the  medium  of  the  ftomach, 
may  produce  it. 

O  2 


gerous  exhalement   which  may  fometimes 
iirife  from  it. 

8.  SEA  ficknefs,    and  a  fea  voyage,   con- 
tribute very  much  to  reftore  the  fecretion 
of  healthy  bile,    fo  neceffary  to  the  welfare 
of  the   animal  ceconomy ;     and   fymptoms 
of  dyfpepfia  and  diminifhed  fecretion,  which 
are  now  rendered  more  confpicuous  among 
females  from  their  fedentary  life,    are  moil 
effectually  removed   by  the   means    already 
fuggefted. 

9.  IN  fome  cafes,     the   refiftance  to  the 
fecretion  of  bile  may  arife  from  the  vifci- 
dity  of  the   fluid    obftruding   the  extremi- 
ties   of    the     common    duct     as     it    enters 
the  duodenum  :  this  will  be  removed  moft 
effectually  by  calomel,  fcammony,   or  jalap, 
which  fbem  in  their  operation  to  ftimulate 
and  evacuate  the  duodenum,     while    many 
other  purgatives  act  moil  forcibly  on    the 
large  inteftines. 

10.  IN     the   infantile  fever  of  children, 


[     H9    1 

fo  well  defcribed  by  Dr.  Butter,  a  bilious 
diarrhoea  comes  on,  which  proves  falutary 
and  critical,  and  fhould  be  encouraged  by 
a  folution  of  fal.  polychreft.  in  water,  and 
fometimes  by  the  occafional  life  of  calomel 
and  fcammony,  eipecially  in  the  early  ftage 
of  the  difeafe. 

ii.  THERE  feems  much  fympathy  be- 
tween the  brain  and  the  liver;  and  in 
maniacal  perfons,  in  whom  there  is  gene- 
rally a  defect  in  the  fecretion  of  bile; 
this  evil  is  beft  removed  by  the  means,  al- 
ready recommended. 


CHAP.    III. 


OF  OBSTRUCTION  TO  THE  FREE 

PASSAGE  OF  BILE  INTO  THE 

DUODENUM. 


SECT.  I. 

A  F,  after  bile  is  fecreted,  its  free  admifiiOH 
into  the  duodenum  be  impeded,  fo  that  an 
accumulation  of  it  takes  place  in  the  excre- 
tory duels  of  the  liver;  it  either  regurgi- 
tates into  the  habit  by  the  hepatic  veins-, 
or  is  abforbed  by  the  lymphatic  fyftem; 
in  either  cafe  it  produces  the  difeafe  called 


C   152  ]' 

JAUNDICE  ;    the  hiftory  and  cure  of  which 
I  fhali  now  endeavour  to  explain. 

2.  JAUNDICE    may    be   defined  a  yellow 
colour  of  the  fkin,    and  tunica  conjunctiva 
of  the  eye,    with  urine  of  an  obfcure  red, 
tinging  line.n  with  a  yellow  hue,    and  with 
the  fasces  generally  of  a  light  and  clay-like 
appearance  in  confiftence  and  colour.  • 

3.  THIS  is    a    difeafe    to   which    women 
are  more   fubject    than   men,     and    adults 
than  children;  though  it  takes  place  occa- 
fionally  in  perfons  of  all  ages  and  of    both 
fexes.     It  is   attended  with  a  fenfe  of  lafli- 
tude  and  languor,  a  fenfe  of  pain   and  ten- 
fion,   or  weight  and  oppreffion   about    the 
prascordia  ;    there  is  frequently  much  anxie- 
ty, and  fome  degree  of  difficulty  in  breath- 
ing.    The  eyes  and  roots  of  the  nails  firft 
become  yellow,  afterwards  the  whole  body, 
which   is  alfo   fometimes  attended  with  an 
itching  of  the  fkin. — The  difeafe  is  often  ac- 
companied with  naufea,  vomiting,  flatulen- 


[     '53    1 

cy,  acidity,  and  indigeftion  j  and  the  fae- 
ces, which  are  commonly  of  a  white  colour, 
have  not  the  ufual  feculent  fmell.  Solid 
food  generally  taftes  bitter  in  the  mouth  in 
fome,  and  in  the  moft  unfavourable  ftate 
of  the  difeafe  there  occurs  hiccup,  and  oc- 
cafional  paroxyfms  of  rigor.,  or  chillinefs. 
The  pain  is  fornetimes  extremely  acute  in  the 
right  hypochondrium,  or  in  the  epigaftri- 
um.  The  flate  of  the  pulfe  varies  -,  in  ge- 
neral it  is  quicker  than  natural,  though  in 
fome  cafes,  efpecially  during  the  pafTage  of 
a  gall  ftone,  it  is  flower.  It  very  feldom 
or  never  happens,  that  objects  appear  to  the 
patient  of  a  yellow  colour. 

4.  THIS  difeafe  is  frequent  during   preg- 
nancy, and  in  early  infancy  ;   in  both,  how- 
ever,   it  is  of  a  very  fhort  duration. 

5.  ITS  decline  is  marked  by  a  gradual  di- 
minution of   the  fenfe  of    weight,  opprefli- 
on,   or    uneafmefs   about  the  prascordia;    a 
return  of  appetite  anddigeftion  -,  the  colour 


[     154    ] 

of  the  urine  becomes  more  diluted ;  it  is 
fecreted  in  a  larger  quantity ;  the  flools  ac- 
quire a  yellow  colour,  are  more  copious, 
and  more  eafily  procured  -,  fometimes  hard 
and  concrete  matter  is  found  in  the  fasces. 

6.  IT  is  a  difeafe  into  which,  a  patient  is 
very  liable  to  relapfe.     It  is  very  unfavour- 
able,   if  the  pain  be  violent,    and  attended 
with  a  quick  pulfe,    lofs    both  of  flrength 
and  flefh,   with  occafional  chillinefs,  watch- 
fulnefs,  and   melancholy;   under  thofe  cir- 
cumftances,    he  becomes  fubject   either  to 
profufefweating  or  hcEmorrhagy.  Whenthefe 
fymptoms  attend   it,    the  difeafe  frequently 
terminates  in  a  confirmed  afcites. 

7.  UNDER    fuch   circumftances    we   may 
conclude,   that   though  fome  bile  mufl  be 
fecreted,     and    that   its     regurgitation,    or 
abforption,     is    the    confequence   of    fome 
refiftance  to  its  free  ingrefs  into  the  duode- 
num ;   yet  that  apart  of   the  liver  is,  in  its 
ftrufture,  or  organization,    materially   dif- 


[    '55    1 

eafed,  a  circumflance  which,  though  fre- 
quently attendant  on  jaundice,  is  by  no 
means  neceflary  to  coniiitute  the  difeafe. 

8.  ON     diflection,    various    appearances 
prefent   themfelves    to   our    notice.      The 
brain,    the  bones,  and  even  the   cartilages, 
are  found  deeply  tinged  of  a  yellow   colour. 
The  pori  biliarii,  and  forrie   of  the  larger 
branches  of  the  hepatic   duels,    are  found 
fometimes  obliterated    by    difeafed   ftruc- 
ture.     Gall  flones   are  often  found   in   the 
duftus  communis,  but  more  frequently   in 
the  gall  bladder  and  cyftic  duct.     In  fome 
a  thickening  and  difeafed   flrudture  of  the 
ductus    communis    has    taken   place,    not 
unlike  what  has  been  obferved  in  the  cefo- 
phagus  or  urethra.      In   many  cafes    there 
have  been  appearances  of  mechanical  pref- 
fure  from  the  diftention  and  tumour  of  fur- 
rounding  and  neighbouring  parts,  as  of  the 
pancreas,   duodenum,   and  colon,  either  of 
a  temporary  or  permanent  nature  j  hence  a 


[     '56    ] 

jaundice  may  arife  from  prefTure  during 
pregnancy.  The  bile  has  been  found  of  a 
very  vifcid,  and  pitchy  confidence,  efpeci- 
ally  in  the  gall  bladder,  paffing  from  the 
cyflic  to  the  common  duel,  and  thereby 
perhaps  refilling  the  paffage  of  the  more 
fluid  hepatic  bile,  which  would  otherwife 
flow  freely  into  the  duodenum. 

9.  THE  Morofis,  to  which  young  women 
are  extremely  fubjccl:,  to  a  fuperficial  ob- 
ferver,  puts  on  the  appearance  of  jaun- 
dice. In  the  chlorofis,  the  tunica  conjunc- 
tiva is  not  more  difcoloure.d  than  any  other 
part  of  the  body,  and  the  urine  is  not  of  a 
deep  colour,  but  rather  pale  and  limpid. — I 
am  perfuaded,  however,  that  in  chlorotic 
habits  the  bile  is  more  infipid,  is  fecreted  in 
lefs  quantity,  and  of  a  more  pale  colour 
than  in  health.  This  imperfect  flate  is, 
perhaps,  in  common  to  all  the  other  fecreti- 
ons  of  chlorotic  fubjeds,  and  may  poflibly 
arife  from  the  watery  flate  of  the  blood, 


[     '57    1 

the  paucity  of  red  particles,  and  the  .defec- 
tive energy  of  the  whole  fyftem. 

10.  IN  the  endemic  fever  of  the  Weft 
Indies,  in  which  the  fkin  is  obvioufly 
tinged  with  bile,  there  feems  rather  a  re- 
dundancy of  it  in  the  primas  vise,  than  a 
deficiency.  Perhaps  the  quantity  of  bile 
which  is  fecreted  is  fo  very  confiderable,  that 
though  the  greateft  part  of  it  efcapes  into 
the  primas  vise,  the  whole  may  not  readily 
find  a  pafTage ;  and  the  furcharge  thus  occa- 
fioned  may  give  rife  to  regurgitation  and 
abforption.  The  reafon  for  this  may  proba- 
bly be,  that  the  diameter  of  the  common 
duel,  or  of  the  larger  branches  of  the  pori 
biliarii,  though  fully  adequate  to  tranfmit 
the  whole  of  the  bile  fecreted  in  the  healthy 
flate  of  the  liver,  yet  may  be  infurHcient  to 
convey  the  excefs  produced  under  an  hurried 
and  imperfect  action  of  that  organ  -,  and 
therefore  with  every  appearance  of  a  large 


[     158    ] 

fupplyof  bile  in  the  primse  vias,  a  jaundice 
may  take  place. 

11.  THE  fymptoms  of  pyrexia,  and  other 
phenomena  of  febrile  miafmata  acting  on  the 
body  under  this  difeafe,  the  delirium,     the 
quick  proftration   of   ftrength,  /after    early 
fymptoms  of  local  inflammation,    either  in 
the  duodenum,   or    region    of  the    biliary 
duels,  diilinguifh  it  very  readily  from  jaun- 
dice. 

12.  THE   fecretory    ceconomy   of  the 
liver,   in  common  with  that  of  mod  other 
organs  in  the  body,    is  very  much  under  the 
dominion  of  the  paffions.      Anger,     it  is 
well  known,     produces     ftrongly    marked 
effects  ;   it  not  only  augments  the  quantity 
of  bile  fecreted  very  confiderably,   butlike- 
wife  vitiates   it :.  hence  it  is,    that  by  being 
carried  into  the  duodenum  in  large  quanti- 
ties,   and  thence  regurgitated  into   the  flo- 
mach,  it  produces  effects   like  thofe  of  an 
emetic. 


13-  IF  the  ductus  communis  docs  not 
tranfmit  it  as  faft  as  it  is  fecreted,  and  the 
gall-bladder  is  fo  full  that  it  cannot  receive 
the  excefs;  then  it  will  be  forcibly  returned 
upon  the  hepatic  fyftem,  and  by  entering 
the  blood  veflels  produce  jaundice. 

14.  IT  feldom  happens,  when' a  fecreti- 
on  is  hurried  by  the  exc'cfs  of  action,  that 
the  fluid  fecreted  pofiefTes  its^  natural  and 
healthy  properties;  hence  arifes  the  varia- 
tion in  appearance  of  bile,  which,  in  fome 
acute  cafes,  as  in  cholera  rnorbus,  I  have 
feen  of  a  colour  as  black  as  foot,  fo  as  to  re- 
femble  more  the  red  particles  of  the  blood, 
in  a  broken  or  difeafed  flate,  than  the  bile.' 
Such  a  fluid  may  be  confidered  as  fomething 
between  blood  and  bile,  and  carried  off  fo 

41 

quickly,  that  the  procefs  of  making  bile 
had  only  juft  begun,  though  the  change  in 
the  condition  of  the  blood  with  a  view  to 
that  procefs  had  taken  place.  This  could 
not  have  depended  on  any  difeafed  ftructure, 
p  2 


[     160    ] 

for  it  is  inftantly  removed  by  opiates  and 
other  means  which  may  reflrain  immoderate 
action. 

15.  ME:;  engaged  in  literary  purfuits, 
and  women,  from  leading  fedentary  lives, 
are  very  much  difpofed  to  jaundice  and  other 
difeafes  of  the  abdominal  vifcera  -,  for  the 
excretory  powers  of  the  liver  depend  but 
little  upon  any  action  which  the  biliary  ducts 
can  perform,  as  they  pofTefs  a  very  fmall  de- 
gree of  irritability;  but  are  aflifted  prin- 
cipally from  the  agency  of  the  diaphragm, 
abdominal  mufcles,  and  periftaltic  motion 
of  the  inteitines  -,  and  more  efpecially  from 
the  agitation  which  the  ^hepatic  fyflem  fuf- 
fers  duringbodily  exercife.  Thewant  there- 
fore of  a  degree  of  exercife  fufficient  to  aflift 
the  biliary  duels  in  their  excretory  function, 
muft  neceffarily  lay  an  ample  foundation  for 
morbid  affections.  And  the  neceflity  of  this 
external  aid  to  the  perfect  action  of  the  li- 
ver, feemsmore  obvious  from  the  circum- 


ftances  of  its  venous  circulation,  which  is 
always  more  languid  than  in  thofe  fecretory 
organs  where  the  fluids  are  kept  in  a  flate  of 
more  rapid  motion  by  arterial  impulfe, 
Horfe  exercife  feems.  peculiarfy  well  calcu* 
lated  to  affift  the  action  of  the  abdominal 
vifcera,  in  cafes  of  defective  excitement  in 
the  hepatic  fyftem.- 

16.  THE  bile,    during  its  flay  in  the  gall 
bladder,  acquires  a  vifcid  confidence,    per- 
haps, in  fome  meafure,  from  the  abforption 
of  its  more  aqueous  parts,  and  likewife  from 
a  propenfity   to  fpontaneous   feparation,    by 
which  its  coagulable  part  may  detach  itfelf. 
Though  this  circumftance  is  lefs  obvious  in 
bile  than  in  blood,  and  though  it  may  re- 
quire more  time  to  be  effected,  yet  I  think 
it  probable,   from    analogy,  that  fuch  a  fe- 
paration of  its  parts  may  take  place. 

17.  IN  many    cafes  we   find  the  abufe   of 
fpirituous    liquors     difpofes    to   'jaundice, 
evidently  of  the  moil  unfavourable  kind  3 

p  3 


becaufe  generally  accompanied  with  dil- 
eafed  ftruclure.  They  may  ad  by  firft  al- 
tering the  ftructure  of  the  ftomach  and  duo- 
denum, and  afterwards,  by  fympathy  of 
contiguity,  affect  ihe  biliary  duels  of  the 
liver.  In  the  direction  of  thofe  who  have 
been  intemperate  dram-drinkers,  the  difeaf- 
ed ftructure  may  be  traced  from  the  ftomach 
along  the  courfe  of  the  ductus  communis, 
and  I  have  frequently  feen  thefe  ducts  fo 
contracted  and  thickened,  that  they  could 
not  tranfmit  bile.* 

*  I  was  informed  by  the  late  Mr.  Hunter,  that 
the  ftomachs  of  dram-drinkers  are  generally  found 
in  a  flabby  and  inelaftic  ftate,  capable  of  fecreting 
only  difeafed  fluid:  ,his  lofs  of  tone  in  the  fto- 
mach is  followed  by  frequent  vomiting,  tremulous 
motions  of  the  mufcles,  propenfity  to  palfy,  and 
lofs  of  memory — In  many  cafes,  as  has  been  al- 
ready obferved,  the  liver  is  fo  far  difeafed  that  it 
does  not  even  fecrete  bile,  and  a  pallid  and  un- 
healthy afpect  takes  place. 

The  urine  is  fecreted  in  a  fmall  quantity,  of  a 
deep  colour,  though  not  tinging  linen  of  a  yellow 


C   163   ] 

1 8:  HOWEVER  remotely  fitnated  fome 
parts  of  the  body  may  be  from  others;  yet 
a  difeafed  action  is  quickly  propagated  to  a 
diftance,  without  affecting  intermediate 
parts  :  and  it  frequently  happens,  that  an 
attempt  to  cure  the  difeafe  of  a  part,  is 
followed  only  by  its  removal  to  fome  other 
organ  of  the  body  ;  hence  the  fupprefllon 
of  iffues,  cutaneous  eruptions,  and  hasmor- 
rhoids,  are  followed,  in  fome  cafes,  by  mor- 
bid affections  of  the  lungs,  in  others  of  the 
hepatic  fyftem,  and  thefe  do  not  always 
fubfide  on  reftoring  the  difeafed  action  to 
the  organ  firft  affected.  In  confirmation  of 
this  opinion,  I  have  feen  a  jaundice  with  a 
fenfe  of  .pain  and  opprefiion  on  the  right  hy- 
pochondrium,  correfpond  and  alternate  with 

hue.  This  is  frequently  a  more  dangerous  (late 
of  difeafe  than  jaundice,  which  indicates  only  a 
refiftance  to  the  pafTageof  bile  into  the  duodenum, 
and  may  take  place  in  the  moft  healthy  ftate  of 
the  liver. 


t  164  ]^ 

piles,  and  habitual  difcharges  of  pus  in  the 
lower  extremities. 

19.  IT  is  generally  admitted,  and  I  think 
fufficiently  proved  by  fome  experiments  al- 
ready  mentioned,  that  the  biliary  ducts  are 
very  paffive,  that  they  fubmit  very  eafily  to 
mechanical  diflenfion  from  calculi,  without 
contracting  afterwards  like  fenfible  or  irri- 
table parts  ;  therefore  when  jaundice  has 
arifen  from  very  acrid  emetics,  or  griping 
purgatives,  or  colic,  or  hyfteria,  the  refifl- 
ance  to  the  free  paflage  of  bile  is  either  at 
the  very  extremity  of  the  ductus  communisj 
or  during  its  oblique  courfe  through  the 
fubftance  of  the  duodenum,  at  which  part 
it  is  liable  to  comprefllon  from  the  mufcular 
action  of  that  inteftine.  And  perhaps,  like- 
wife,  the  increafe  of  the  quantity  of  bile  in 
the  inteftine  may  depend  on  an  action  com- 
municated to  the  ductus  cbmmunis.  In 
the  one  cafe  the  duct  may  be  clofed,  in  the 
other  it  may  be  acted  upon  by  fuccefTive 


3 

motions,  by  which  it  emulges  more  quickly 

its  contents. 

i 

20.  WHEN  we  were  treating  of  the  natu- 
ral and  chymical  hiftory  of  the  bile,  we  an- 
nexed fome  obfervations  on  the  appearances 
and  component  parts  of  biliary  calculi,  which 
will  fuperfede  the  necefiity  of  a   repetition 
of  them   in  this  place.     It  will  be  proper 
here,  however,  to  remark,  that  fuch  concre- 
tions do  not  occur  in  every  part  of  the  bilia- 
ry fyftem  with  equal  frequency  ;  from  dif- 

fection  it  appears  that  they  very  rarely  exifl 

» 
in  the  hepatic  duels,  fometimes  met  with  in 

the  ductus  communis,  more  frequently  in 
the  ductus  cyflicus,  and  are  moft  common 
in  the  gall  bladder.  The  bile  accompany- 
ing them  is  more  vifcid  than  ufual,  and 
appears  to  contain  a  larger  portion  of  the 
colouring  and  bitter  principles. 

21.  THE  number  and  fize  of   thefe   cal- 
culi vary  much  :  fometimes   the  gall  blad- 
der is  filled  with  them,   at  others  there  are 


[     166    ] 

not  more  than  one  or  two  ;  fometimes  they 
are  fmall  and  angular,  at  others  large,  and 
have  a  more  regular  furface.  I  have  feen  a 
gall  ftone  nearly  the  fize  and  figure  of  the 
gall  bladder  itfelf,  fo  as  nearly  to  fill  the 
whole  cavity.  Thefe  large  calculi  are  iefs 
frequently  the  caufe  of  jaundice  than  fmaller 
ones  :  for,  from  their  bulk,  there  is  but 
little  probability  of  their  entering  the  ductus' 
cyflicus,  and  afterwards  of  obfiructing  the 
ductus  communis.  It  is  from  calculi  of 
fmaller  dimenfions  that  fuch  obstructions 
are  occafloned.  However  the  rule  is  not 
without  exceptions,  and  from  diflection  it 
appears,  that  calculi  of  confiderable  bulk 
muft  have  patted,  for  the  ductus  communis 
has  been  enlarged  to  an  inch  in  diameter, 
an  inftance  of  which  has  been  met  with  by 
Dr.  Heberden. 

9.2.  BUT  calculi  have  pafTed,  during  life, 
of  fuch  a  bulk  as  to  occafion  a  doubt  whe- 
ther they  efcaped  into  the  intefunes  by  the 


I    '67    1 

natural  canals,  or  made  their  way  thither 
by  a  preternatural  pafTage.  Dr.  Cheflon, 
fome  years  ago,  met  with  a  cafe  where  a 
gall  flone  of  an  unufual  magnitude  pafTed 
during  life,  and  the  patient  got  well. 
Some  years  after  fhe  died  of  another 
complaint,  and  on  examination  it  appeared 
that  this  large  gall  flone  had  made  a  pre- 
ternatural pafiage  through  the  gall  bladder 
into  the  inteftine.  Mr.  Cline,  in  his  excel- 
lent collection  of  anatomical  preparations 
.  at  St.  Thomas's  Hofpital,  has  an  inftance 
of  a  cafe  of  this  kind. 

23.  A  PERMANENT  jaundice  has  fre- 
quently arifen  from  furrounding  tumours 
comprefling  the  hepatic  du&s :  a  fchirrous 
enlargement  of  the  pancreas,  has  fome- 
times  produced  this  effeft.  ExcefTive  vo- 
miting, and  violent  exercife,  perhaps  by 
forcing  ftones  from  the  gall  bladder  'into 
the  cyftic  duel:,  and  from  thence  into  the 
common  du6l,  have  produced  the  difeafe. 


[    168    ] 

There  is  an  inftance  where  jaundice  arofe 
from  the  feeds  of  goofeberries  being  found 
in  the  extremity  of  the  ductus  communis 
as  it  enters  the  duodenum.     In  fhort,  what- 
ever can  obftrucl  or  impede  the  pafTage  of 
the  bile  into  the  duodenum,  muft  be  confi- 
dered  as  a  caufe  fufficient  to  produce  jaun- 
dice :    but  in  what  way  the  bile  pafTes  from 
the  biliary  veflels   into  the  general  circula- 
tion,  has  already  been  explained  in  thephy- 
fiological  part  of  this  work. 

24.  THE  jaundice,    when     arifing  from 
a  difeafed  ftate  of  the  ftructure  of  the  liver, 
or  from  the  tumour  of  ftirrounding  parts, 
and  more  efpecially  if  accompanied  with  fe- 
ver and  gradual  diminution  of  ilrength  and 
fleih,   is  feldom  cured,   and  generally   ter- 
minates in  afcites. 

25.  IF,   on  the  other  hand,  it  has  arifen 
fuddenly    in    young   and     vigorous   habits 
(though  accompanied  even  with  much  pain), 
unattended  with  fever  and   the  other  unfa- 


[     i69    3 

vourable  circumflances  above  remarked, 
it  is  feldom  of  long  duration,  and  by  a  ju- 
dicious treatment  may  be  effectually  re- 
moved. 

26.  THE  cure  of  jaundice  con  (Ids    in  the 
removal  of  exciting  caufes,   and  in  allevi- 
ating urgent   fymptoms.      Calculi   are   the 
mofl  frequent  exciting  caufes, 

27.  Ir appears     from     experiments   that 
fome  calculi  are  foluble  in    an    alkali,    in 
fpirit  of  wine,    and  oil  of  turpentine  ;    but 
it   is   altogether   impracticable  to   make   a 
direct    application    of  thofe   fubftances  to 
calculi   in  the  biliary  duels,   as  we  have  no 
facts  to  prove,   that  by   the  courfe  of  cir- 
culation, they  can    be  carried  into  the  gall 
bladder  fo  little  changed  as  to  preferve   any 
fenfible  degree  of  pow-er.    ,  It   remains  yet 
to  be  proved,    that   the  proportion  of  al- 
kali in    the    bile    is  increafed   by  alkaline 
remedies. 

28.  MANY   faline  remedies  pafs  into  the 


[    *  7°    1 

urine  unchanged,  and  may  act  on  calculi 
in  the  bladder  -,  but  we  cannot  detect  the 
prefence  of  alkaline  or  other  folvents  in  the 
bile.  The  analogy,  therefore,  between  the 
action  of  folvents  in  biliary  and  urinary  cal- 
culi will  not  obtain. 

29.  THE  paffage  of  gall  ftones  may  be 
promoted  by  gentle  vomits,    and  for   this 
purpofe  ipecacuanha  may  be  given  ;  but  its 
action  will  be  affifted  if  it   be  exhibited  in 
fmall  and  divided  dofes,  fo  as  to  occafion, 
for  a  time,  a  degree  of  naufea,  but  ultimate- 
ly to  produce  the  full  effect  of  an  emetic. 
And,    perhaps,   it  is  on  this  principle  that 
fea-ficknefs,  in  thofe  cafes,  has  been  fo  very 
efficacious. 

30.  THE  duodenum  may  be   ilimulated 
by  calomel  combined   with  fcammony  or 
rhubarb,  and  in  cafes  of  a  defect  of  bile  in 
the  inteftinal  canal,    the    deficiency  may  be 
fupplied  with  a  purgative  bitter,  by  an  infu- 


fion  of  camomile  flowers,  with  tincl.  aloes, 
or  colomba,  with  rhubarb  and  foap,  or  kali 
vitriol,  with  infuf.  rhei.  In  cafes  of  violent 
pain,  with  a  flow  pulfe,  opiates  and  tepid 
bathing  may  be  recommended.  In  cafes  of 
pyrexia,  with  local  pain  and  dyfpncea,  venas 
fec>io  and  the  antiphlogiftic  regimen  may 
be  ufed  with  advantage. 

31.  GENTLE  exercife  on  horfeback  is  par- 
ticularly ufeful  in  promoting  the  paflage  of 
calculi,    and  preventing   the  ftagnation   of 
bile   in    the    gall-bladder,  which    probably 
renders  it  vifcid,   and  liable  to  obftruct  the 
free  paflfage  into  the  duodenum. 

32.  IN  jaundice  from  tumour  or  prefTure 
>of  furrounding  parts,    fmall  dofes  of  calo- 
mel,   or  fome  other  mercurial  preparation, 
may    be   ufeful,    unlefs  fymptomatic  fever 
ihould  take  place,   in  which  cafe  mercury  is 
hurtful.     Chalybeate  waters  may  be  ufed  to 
advantage  with  a  view  of  giving  tone  and 

0.2 


[     172     I 

energy  to  the  fyftem,   fo   very   defective   in 
cafes  of  jaundice.* 

*  Mr.  Dick,  a  gentleman  high  in  the  profeffi- 
onal  line,  in  Bengal,  and  of  much  practice  in  Cal- 
cutta, in  a  letter  to  me,  fays, "  I  have  been  for 

"  the  laft  feven  years  in  the  habit  of  giving  calo- 
"  me!  in  the  jaundice,  in  dofes  from  two  to  five 
tc  grains  every  night,  till  the  mouth  was  affected, 
"  and  in  every  cafe  the  jaundice  went  off  as  foon 
"  as  the  mouth  became  fore. — I  now  fcarcely  ufe 
"  any  other  medicine,  except  merely  to  prevent 
"  coftivenefs. — I  cured  upwards  of  forty  patients 
"  in  that  way,  and  all  in  lefs  than  a  month>  gene- 
"  rally  in  ten  days,  or  a  fortnight." — The  fame 
gentleman,  in  a  fubfequent  letter  to  a  friend,  after 
paying  many  compliments  to  my  Treatife  on  the 

Liver,  fays,- "  I  think,  however,  that  Dr.  S. 

"  has  not  fo  high  an  opinion  of  the  good  effects 
t(  of  mercury,  in  liver  complaints,  as  it  deferves. 
((  I  have  been  confirmed  more  and  more  by  late 
"  practice,  in  my  opinion,  of  its  effects  in  the  jaun- 
"  dice,  though  I  do  not  attempt  to  reafon  upon  it. 

ts  In  recent  attacks  of  liver  complaints,  after 
<c  early  bleeding,  bliftering,  and  the  free  ufe  of 
"  laxatives,  I  never  faw  a  cafe  where  fuppuration 
"  came  on,  if  mercury  was  freely  ufed,  and  conti- 
"  nued  till  the  mouth  was  fore  j  and,  if  I  be  not 
"  much  miftaken,  it  is  in  fuch  cafes  that  it  has  the 
4C  beft  effects.—- In  chronic  cafes,  where  there  is 


c<  no.  fever,  but  only  an  obtufe  pain  in  the  fide  and 
"  fhoulder,  with  a  fullnefs  in  the  iide,  and  about 
(t  the  pit  of  the  ftomach,  keeping  up  a  conftant 
"  uneafinefs,  mercury  feems  to  me  to  have  but 
"  little  good  effects  :  when  ufed  freely  it  removes 
"  the  fymptoms  at  the  time,  but  they  generally  re- 
"  turn  as  foon  as  the  mercury  is  left  off.  Having 
«  been  repeatedly  baffled  in  this  way,  and  obferv- 
"  ing  very  often  that  fuch  liver  attacks  fucceeded 
"  long  courfes  of  mercury,  undergone  for  the 
"  cure  of  venereal  complaints,  I  have  for  feveral 
"  years  paft  trufted  to  a  feton  or  iflue  made  in  the 
"  fide,  and  with  fuccefs  far  beyond  my  expeda- 
<c  tions." 

Thefe  being  the  remarks  of  a  gentleman  of 
much  practice  and  obfervation,  I  have  given  them 
in  his  own  words,  being  convinced  that  they  de- 
ferve  the  particular  attention  of  thole  who  prac- 
tice in  India. 


C   175  I 


CHAP.     IV. 


OF  THE  DISEASES  TO  WHICH'THE 

LIVER  IS  SUBJECT  IN  COMMON 

WITH  OTHER  ORGANS  OF  A 

GLANDULAR  STRUCTURE. 


SECT.     I. 

JL  H  E  liver  is  fufceptible  both  of  acute 
and  chronic  inflammation ;  perhaps  of  the 
former,  as  being  more  immediately  con- 
nedted  with  its  arterial  or  nutrient,  the  latter 
.with  its  venous  or  fecretory  fyftem.  When 


the  liver  is  feized  with  acute    inflammation 
the  difeafe  is  called  Hepatitis. 

2.  IT  is   generally    preceded     by    fome 
degree  of  horripulatio  and   rigor,  which  in 
fome   cafes,   however,    are  fo  flight  as   to 
evade  the   attention   or  recollection  of  the 
patient;  to  thefe  fucceed  an  increafe  of  heat 
and  quicknefs  of  pulfe.     The   pain  in  the 
right  bypochondrium,  or  region  of  the  liver, 
is  very  acute,  attended   with  difficult  and 
painful  refpiration,   great  watchfulnefs,  and 
occafional  delirium.     The  patient  lies  with 
more  eafe  on  the  right  fide.     The  urine  is 
fecreted  in  fmall  quantity,   is  high  coloured, 
and  frequently  tinged  with  bile.    The  tongue 
is  generally  covered  with  a  white  cruft,  and, 
together  with  the  mouth  and  fauces,    is  ex- 
tremely dry.     Thefe  are  the  leading  fymp- 
toms  of  Hepatitis. 

3.  THE  fymptoms  are  fomewhat  varied, 
according  to  the  particular  part  of  the  liver 
which  may  happen  to  be  the  feat  of  the 


3 

• 

difeafe.  If  the  inflammation  attack  the 
convex  furface  of  the  liver,  fo  that  the  pe- 
ritoneum becomes  affected,  the  pain  is  much 
increafed  by  external  preffure,  and  fome  de- 
gree of  tumour  may  be  obferved.  If  that 
part  of  the  organ  be  difeafed  which  is  more 
immediately  contiguous  to  the  diaphragm, 
it  gives  rife  to  difficult  and  painful  refpirati- 
on,,  dry  and  frequent  cough,  acute  fhooting 
pains  in  the  thorax,  extending  to  the  hume- 
rus,  clavicle,  and  fcapula. 

.  4.  THESE  fymptoms,  from  the  refem- 
blance  they  bear  to  thofe  of  pleurify,  peri- 
pneumony,  and  other  inflammatory  affec- 
tions of  the  chefr,  are  apt  to  miflead  an  un- 
wary practitioner ;  but  are  to  bediftinguifh- 
ed  from  them  by  an  attention  to  the  hiftory 
and  progrefs  of  the  complaint. 

5.  IN  fome  cafes  of  Hepatitis  the  ilo- 
mach  is  fo  extremely  irritable,  that  violent 
retching  or  vomiting  occur,  fymptoms  in- 
fluenced, perhaps,  by  the  inflammation 


being  in  the  vicinity  of  that  organ.  In  mod 
cafes  the  fecretion  of  0  bile  is  increafed  under 
active  inflammation,  though  its  paffage  into 
the  duodenum  is  frequently  impeded,  fo  that 
jaundice  is  no  uncommon  fymptom  of  this 
difeafe. 

6.  IF   the    fymptoms  of  fever  and  local 
pain  continue  to  increafe  rapidly  for  a  few 
days,    a  fuppu ration    takes   place,    a  large 
quantity  of    pus  is   formed,    the    external 
tumor  becomes  more  prominent,  a  fluctuati- 
on may  be  perceived,    fo  as  fuccefsfully  to 
direct  the  operation    of  the  furgeon  to  an 
artificial  opening  by  the  cauflic  or  the  lancet. 
During  the  formation  of  pus  frequent  rigors 
are  felt,  and  a  fenfe  of  weight  and  opprefllon 
fucceeds  that  of  acute  pain, 

7.  IT   frequently   happens    that    pus   is 
formed  either  in  the  vicinity  of  the  duftsy 
or  in  the  concave  part  of  the  liver;  fo  that 
no  external  tumor  can  be  perceived.     The 
ufual   fymptoms  of  fuppuration,    however, 


C    179   ] 

may  be  obferved  in  all  cafes  where  matter 
is  produced  j  and  if  the  outlet  to  it  be  free 
and  open  by  the  inteftines,  the  patient  fre- 
quently recovers,  even  after  being  much 
emaciated,  and  under  appearances  extreme- 
ly unpromifing.  If  again,  on  the  other 
hand,  the  pu$  is  difcharged  either  through 
the  diaphragm  into  the  cavity  of  the 
thorax,  or  more  direclly  into  that  of 
the  abdomen,  the  difeafe  generally  proves 
fatal. 

8.  WITH  refpedlto  the  manner  in  which 
the  difcharge  is  effefted  in  thofe  cafes  where 
it  pafTes  off  by  the  inteflines,   it   muft   be 
clear  that  fome  of  the  branches  of  the  he- 
patic duel  are  involved  in  the  fuppuration, 
and  confequently  deftroyed  by  the  ulcerative 
procefs. 

9.  WE  fhould  then  naturally  fufpect  that 
the  pus  would  infmuate  itfelf  into  thofe  ori- 
fices of  the  hepatic  duels,  which    ulceration 

"had  formed,  and  by  thofe  channels  make  its 


way  into  the  duodenum. — But  this  explana- 
tion is  not  unattended  with  difficulty  :  for 
it  muft  be  recollected,  that  wherever  fuppu- 
ration  and  ulceration  are  going  forward, 
there  adhefion  is  an  attendant. 

10.  IT    would    be    departing   from    the 
main    object    of  this    work   to    branch  off 
into  a  digrefllve  inquiry  on  the  advantages 
refultirig  to  the  machine  from  this  connexi- 
on of  inflammatory  flages,    as  thofe  advan- 
tages are   as  much   diverfified  as  the  parts 
which  are  the  feat  of  inflammation.     It  js 
in  place  here,  however,  to  obferve,    that  an 
abfcefs  of  the  liver,   in   common  with  other 
parts,  has  its  boundaries    circumfcribed  by 
the  effufion  of  coagulable  lymph  fo  changed 
by  pafTing   through  inflamed  veflels,    that 
the  parietes  of  that  abfcefs  become  fold ered 
into  a  folid  compact  mafs.     Thus  an  abfcefs 
which,  under  contrary  circumilances,  would 
have  diffufed  itfelf  to  an  indefinite   extent, 
now  becomes  determined  and  circumfcribed. 


ii.  THESE  conilderations  prepare  us  fora 
change,  which  mufl  neceffarily  be  induced 
on  the  ulcerated  branches  of  the  ,bepatic 
du<5l;  the  coagulable  lymph,  which  is  eve- 
ry where  poured  out  upon  the  internal  fur- 
face  of  the  abfcefs,  will,  in  all  probability, 
fo  obflruct  the  ulcerated  orifices  of  the  bili- 
ary duels,  that  no  pus  can  make  its  way  by 
them  into  the  inteflines. 

12.  NOTWITHSTANDING^  this,    I  think   it 
very  probable  that  an -abfcefs  may  point  on 
the  concave  furface  of  the  liver,  and  fo  far 
involve  the  hepatic  duel:,  that  it  may  ulce- 
rate through  its  coats,  and  allow  the  matter 
to  pafs  into  the   duodenum.     Whether   we 
may  be  able  to  diftingnifh  fuch  a  cafe  in  the 
living  fubject  is  rather   doubtful;     but    I 
fhould  fufpecl:  that  the  difcharge  of  pus  by 
the  inteftines  will  be  very   gradual,    as   the 
opening  of  communication  is  rather  fmall. 

13.  PERHAPS  the  molt  ufeful   evacuation 
of  hepatic  abfcelTes  by  the  inteftinal  canal 

R 


is  that  where  an  adhefion  takes  place  between 
the  fuppurating  part  and  the  inteftines, 
an  ulceration  enfues,  and  the  contents  of 
the  abfcefs  have  a  ready  pafTage  into  the  in- 
teftines. This  may  happen  in  different  parts 
of  the  inteftinal  canal,  according  to  the 
Htuation  of  the  abfcefs. — When  it  is  feated 
at  the  concave  part,  the  duodenum  may  be 
favourable  for  thatpurpofe;  but  when  the 
lower  edge  of  the  liver  is  the  part  concern- 
ed, the  great  arch  of  the  colon  is  the  ufual 
outlet ;  and  in  thefe  cafes  it  is  highly  pro- 
bable, from  the  fcale  of  the  parts  concerned, 
that  the  opening  of  communication  will  be 
more  extenfive,  and  the  difcharge  of  the 
matter  more  free.* 

*  This  view  of  the  complaint  accords  general- 
ly with  that  of  my  friend  Dr.  Cheflon,  who  fa- 
voured the  world  with  his  thoughts  on  this  fubjcft 
many  years  ago,  in  his  publication  called  Patho- 
logical Inquiries  and  Obfervations,  a  work  not 
lefs  diftinguifhed  for  accuracy  of  obfervation  than 
valuable  for  the  judicious  remarks  it  contains. 


E 

14.  THE  difeafes  which  are  miftaken   for 
hepatitis     are     peripneumony,     inflamma- 
tion of  the  flomach,    and  rheumatic  affec- 
tions of  the   mufcles   in    the  neighbouring 
parts.- 

15.  THE   hepatitis    is   lefs    eafily   diftin- 
guifhed    from    peripneumony    when    that 
part  of  the  liver  is  affected  which  is  feated 
within  the  falfe  ribs,    and  where  it  enlarges 
itfelf  in  fuch  a  direction  as  to  make  aprefTure 

•  on  the  diaphragm  fufficient  to  diminifh  the 
cavity  of  the  cheft  :  and  it  is  probable,  like- 

•  wife,    that  from  the  extenfion  of  the  inflam- 
mation into  the  fubflance  of  that  organ,   its 
operation  as  an  inflrument  of  refpiration  may- 
be   much  impeded. — Under  thefe  circum- 
ftances  a  troublefome  cough,   with  difficulty 
of  breathing,   comes  on ;    fo  that  the   dif- 
eafe  afiumes  the  appearance  of  thoracic  in- 
flammation. 

1 6.  IT  is  more  eafily  diftinguifhed  from 
the  inflamed  condition  of  the   flomach,  by 

R  2 


.[     '84    ] 

its  not  being  accompanied  with  that  extreme 
fenfe  of  heat  and  pain  with  which  that  or- 
gan is  affected,  efpecially  after  taking  any 
thing  into  it;  nor  is  the  debility  of  the 
fyftem  fo  great  in  the  inflammation  of  the 
liver  as  in  -that  of  the  ftomach, 

17.  IN  the  cafe  of  mnfcular  pain  there  is 
little  or  no  fever ;  the  pain  is  more  diffufed, 
is  frequently  removing  from  place  to  place, 
and  is  more  influenced  by  varying  the  pof- 
ture   of  the   body :    it  generally   alternates' 
with  rheumatic  pain  in  one  or  more  joints 
of  the  body.  • 

18.  WHEN  the  hepatitis  terminates  fpon- 
taneoufiy  and  favourably  there  is  fome  eva- 
cuation   by    hcemorrhagy,    diarrhoea,    per- 
fpiration,    or    a   copious    fediment    in   the 
urine.   In  fome  cafes  I  have  feen  a  great  in- 
creafe  of  bronchial  fecretion  accompanying 
the  refolution   of  this  difeafe  ;   and  it  is  not 
improbable  but  that  a  fuperficial   difchargc 
of  coagulable  lymph  may  promote  this  re- 


folution,   though   afterwards   productive  of 
adhefive  inflammation. 

19.  IT  has    frequently   happened  that   a 
large    abfcefs    has     very     quickly   formed, 
which,   either  by  corroding  the  large  blood 
veflels,    or    by   efFufing   pus    into    the  ge- 
neral  cavity    of  the  abdomen,   has   proved 
fatal. 

20.  SYMPTOMS,   indicating  the  formation 
of  matter  in  the  fubftance  of  the  liver  have 
fometimes  fuddenly  ceafed  -,    fo  that  either 
a  tranilation  of  the  difeafe   to  fome  other 
organ  has   taken  place,   or  pus  has   either 
been  quickly  abforbed,   and  been  difcharg- 
ed  by  urine. 

21.  THE  period  of  fuppuration  vanes  ac- 
cording to  the  degree  of  inflammation,  tem- 
perament of  the  patient,  nature  of  the  cli- 
mate, feafon  of  the  year,  or  the  means  of 
cure  whicR  have  been  adopted. 

22.  THE  fymptoms  of  fuppuration  are  not 
always,   however,  very   obvious  •,  the  mod- 


[     186    ] 

finking  of  them  are,  a  diminution  of  pain, 
a  fenfe  of  pulfation,  and  of  weight  in  the 
right  hypochondrium,  efpecially  when  lying 
on  the  left  fide,  frequently  returning  ri- 
gors, an  acceffion  of  fever  towards  the 
evening,  with  flufhings  of  the  countenance,  a 
propenfity  to  profufe  fweating,  and  other 
fymptoms  of  hectic  fever.  In  many  cafes 
the  fluctuation  is  very  apparent.  I  have 
feen  fome  cafes  where  the  pain  and  inflam- 
mation have  fubfided  very  fuddenly,  and 
have  been  fucceeded  by  a  low,  fluttering 
pulfe,  cold  extremities,  deiiquium,  and 
death  :  fo  that  there  has  been  reafon  to  fuf- 
pect  that  this  organ  may  on  forne  occafions, 
though  much  lefs  frequently  than  others, 
become  gangrenous. 

23.  THE  hepatitis  frequently  terminates 
in  the  enlarged  and  fchirrous  ftate  of  the 
organ;  and  we  may obferve,  ongthe  infpec- 
tion  of  dead  bodies,  fuch  a  variety  in  the 
appearances,  as  to  fuggeft  the  idea  of  dif- 


E   187 

ferent  kinds  of  fchirrous  afFedlion,  which 
will  be  beft  explained  by  attending  to  the 
progrefs  of  chronic  inflammation  in  the 
liver,  to  which  fpecies  it  is  more  fubjecV 
than  to  the  acute.  It  is  indeed  fufficiently 
evident  from  direction,  that  the  liver  is 
fubjecl:  to  inflammation,  which  did  not  ob- 
vioufly  appear  from  any  prevailing  fymp- 
tom  before  death  :  though  perhaps  a  more 
accurate  attention  to  circumftances  might 
have  afcertained  the  difeafe.* 

24.  FROM  repeated  obfervation  I  am  in- 
duced to  believe  that  the  chronic  inflamma- 
tion of  the  liver  is  frequently  miftaken  for 
a  dyfpeptic  ftate  of  the  ftomach.  And  I 
have  feen  many  cafes  of  this  kind,  which 
have  been  fuppofed  to  arife  from  indigef- 
tion.  The  patient  generally  complains 

*  For  a  more  particular  account  of  the  difeafed 
ftrufture  of  the  liver,  the  reader  may  confult  the 
Morbid  Anatomy  of  the  Human  Body,  by  Dr. 
Baillie  ;  a  moft  excellent  and  ufeful  book. 


©f  pain,  which  he  falfely  attributes  to  the 
flomach  j  and  its  continuance  is  fo  fhort, 
and  the  degree  of  it  frequently  fo  incon- 
fiderable,  that  no  alarm  refpecting  the  fu- 
ture health  of  the  patient  is  produced.  The 
relief  obtained  by  eructation  and  difchargc 
of  air  tends»to  confirm  the  opinion  that  the 
feat  of  the  difeafe  is  in  the  ftomach  ;  but  this 
relief  may  be  explained  on  the  principle 
of  removing  the  diflention  of  the  ftomach, 
and  fo  taking  off  the  preffure  of  this  organ 
from  that  which  we  believe  to  be  the  feat  of 
the  difeafe.  I  believe  from  experience,  that 
an  attention  to  the  following  circumftances 
will  enable  us  with  fome  certainty  to  dif- 
tinguifli  the  difeafe. 

25.  IN  thofe  cafes  where  the  liver  is 
affected,  confiderable  pain  is  felt  in  the 
parts  near  the  fcrobiculus  cordis  and  epi- 
gaflric  region,  upon  any  degree  of  pref- 
fure; and  as  the  difeafe  advances,  an  in- 
creafe  of  heat,  a  quicknefs  of  pulfe,  and 


other  fymptoms  of  fever,  are  obferved, 
efpecially  towards  night.  The  patient  will 
fometimes  derive  relief  from  bleeding  at 
the  arm,  and  the  blood,  when  drawn,  will 
put  on  thofe  appearances  which  are  com- 
mon to  febrile  complaints  and  diforders  of 
an  inflammatory  nature. 

26.  THE  acute  inflammation   of  the  liver 
is  an    endemic  difeafe  in   warm  climates, 
more  particularly  in  the  Eaft  Indies,  and 
very  generally   terminates   in  fuppuration. 
When  the  fymptoms  of  active  inflammation, 
however,  have  been  checked,   though    not 
effectually  removed,   by  the  antiphlogiftic 
practice,    the    difeafe    frequently     becomes 
chronic,  and    terminates  in  a   fchirrous  in- 
duration of  the  organ. 

27.  ON    this  fubject   much  information 
may  be   obtained  by  obferving  the   coun- 
tenance of  the,  patient,   which,    though  not 
wearing  the   appearance  of  jaundice, 


[     1 90    ] 

has  a  peculiar  fallownefs,    expreflivc  of  a 
morbid  condition  of  the  liver. 

28.  THE  two  complaints   are  not  more 
distinguished  by  their  fymptoms  than  they 
are   by  the  different  flates    of    the    liver 
which  produce  them. 

29.  IN    chronic   inflammation     a  condi- 
tion obtains  in  fome  degree  the  reverfe  of 
the  former.      Inftead  of  appearances  which 
accompany  and  characterife  acute  and  active 
inflammation,  there  are  manifeft  figns  of  in- 
dolence and  want  of  action  in  the  circulating 
fyftem.      The  colour   natural  to  this  organ 
in  the  healthy  ftate,  and  which  appears  to  be 
imparted   to  it   from  the    bile,    is  loft  5     it: 
afTumes  an  afh  or  clay-coloured  hue,  evident- 
ly connected  with  a  diminifhed  fecretion. 

30.  THIS    kind   of   liver    is    obvioufly 
fmaller,    it  undergoes  a  change  in  lhape; 
the  lower  edge,    which   is   naturally   thin, 
efpecially  of  the  left  lobe,   becomes  rounded 
and  gibbous. 


31.  IF  we  cut  into  its  fubftance,  we  find 
uniformly  a  folid  compact  appearance,    in- 
terfperfed    with    foramina,     evidently     the 
orifices  of  divided  vefTels  -,  but  if  we  com- 
pare the  cut  furface  of  a  difeafed  liver  with 
that  of  a  healthy  one,    we  obferve  a  very 
fenfible  difference,    the   latter  being  much 
more  porous  than    the  former.     This  mor- 
bid and  compact  ftate,    together  with  the 
diminifhed  bulk  of  this   organ,   lead  us  at 
firft   view  to  a  fufpicion  that  the  diminifhed 
fize  may  be  explained  on  the  principle  of 
confolidation  of  its  fubftance;   or,    in  other 
words,   that  it   has  gained   in  compactnefs 
what  it  has  loft  in  external  bulk. 

32.  IF    this   explanation    were    juft   and 
adequate,  we  fhould  find  the  liver  of  its  na- 
tural weight;    but   obfervation  has  evinced 
that,   together  with   a  diminution  of  bulk, 
there  is  fome  degree  of  lofs  in  its  weight, 
evidently  proving  that  a  portion  of  its  folid 
fubftance  has  been   removed,    and  carried 


I92 

into  the  general  mafs  of  fluids,   agreeably 
to  a  law  of  the  abforbent  fyftem. 

33.  BUT    I    ftrongly    fufpect    that    this 
diminution    of    fubftance    obtains    in   dif- 
ferent degrees,    according  to  the  period  or 
duration  of  the  complaint.      In   the  more 
early   ftages   of  fchirrofity   the  liver  is  not 
fenfibly  diminifhed  in  its  bulk:    nay,    I  am 
perfuaded  that   there    is   at  this   period  an 
increafe  both  of  bulk  and  weight,   but  that 
afterwards   there  is  a  gradual  diminution  of 
both  ;    and  this   is    nothing  more  than  may- 
be expected,   when  we  confider  the  caufes 
that  occafion  this  difeafe. 

34.  THESE  caufes   are  of  a  nature  which 
tend  to  produce  a  hurried,  and  confequently 
an  imperfect  iecretion  of  bile,  viz.  long  refi- 
dence   in  a  warm    climate,  and  the  immo- 
derate ufe  of  ardent  fpirits. 

35.  BUT,    whatever   be    the   remote    or 
occafional   caufes,    it  mud   be  evident  that 
the    immediate    caufes    can  admit  but   of 


I   193   ] 

little  variety.  To  produce  an  increafed 
fecretion  of  bile,  it  muft  be  evident  that 
there  muft  be  an  increafed  action  of  the 
branches  of  the  vena  portaruuj,  and  an 
accelerated  circulation  of  fluids  through 
thofe  branches :  hence  a  condition  of  vef- 
fels  is  induce^,  approaching  in  fome  refpects 
to  that  of  inflammation,  with  this  differ- 
ence, that  it  is  an  inflammation  in  which 
the  vein,  or  fecreting  veffel,  is  more  con- 
cerned than  the  artery  or  nutrient  yeffel. 

36.  THE  effect  of  this  action,    efpecially 
when  protracted  to  a  confiderable  extent, 
muft    neceflarily    be     that    of  inducing  an 
alteration  in  the  ftructure  of  the  part — an 
alteration  fimilar  to  what  obtains  in  other 
organs   labouring  under  indolent  and  chro- 
nic inflammation. 

37.  THIS   change  of  ftructure,   from  its 
folidity   and  compactnefs,    feems  to  depend 
en  the  cffufion  of  the    coagulable    lymph 
into  the  parenchymatous  fubftance   of   the 


C    194  1 

liver,  with  this  peculiarity,  that  while  it 
is,  in  a&ive  inflammations,  depofited  by 
arteries,  it  is,  in  the  chronic  kind,  effufed 
by  the  veins. 

38.  THUS    we  are  in    poflefTion  of  a 
caufe  <which  appears  to  offer    an  explana- 
tion of  that  diminiihed  fecretion  of   bile 
ufually  met  with  in  fuch   cafes,     where  a 
hurried  or  exceffive  fecretion  was  wont  to 
prevail  :  but  to  proceed  any  further  in  this 
train  of  reafoning  would  be   to  anticipate 
what  we  have  to  propofe  on  the  fubjecl:  of 
the  pa>ximate  caufe. 

39.  IF  the  pofition  juft  flated  be  true,  it 
muft  be  admitted  as   a   confequence,   that 
fuch   livers  are  not   performing  their  full 
{hare  of  that  office  in  the  machine  to  which 
they  were  deftined  by  nature. 

40.  Now  we  know,   that  by  a  law  of  the 
abforbent   fyftem,    fuch   parts  as   ceafe   to 
perform    the    office   nature   intended    they 
fhould  do,  are  confidered  as  ufelefs  bodies, 


[    '95  J 

and  are  fit  fubjefts  for  the  action  of  thefe 
veflels  :  hence  it  is  that  there  is  a  greater 
diminution  of  fubftance  in  thofe  fchir- 
rofities  which  are  of  long  (landing,  than  in 
fuch  as  are  of  more  recent  date. 

41.  To   inquire    in   what   confifts     the 
proximate  caufe    of    inflammation   of     t  he- 
liver,    is   to  inveftigate  what   is  the  proxi- 
mate  caufe  of  inflammation  in  general.-— 
The    limits    prefcribed    to    this   work    do 
not  allow  us  to  enter  extenfively  into  this 
queftion,    as  it  would  involve  an  examin- 
ation  of    the    prevailing   theories   on    this 
fubjecl:. 

42.  FROM    obfervation   we    are    taught 
the  means  that   are  ufed  with  advantage  to 
palliate  and  even  to  remove   inflammation  ; 
and  from    obfervation    likewife    we    learn, 
that  the  fame  means  winch  are  ferviceable 
in   one  inflammation  are  injurious  in  ano- 
ther :    now,    admitting  the   axiom,    "  that 
cc  flmilar  caufes  produce  fimilar  effects  un- 

S  2 


"  der  fimilar  circumftances,"  and  finding 
likewife  that  fome  inflammations  are  aggra- 
vated by  the  very  means  which  cure  others  * 
we  infer  as  a  confequence,  that  the  condi- 
tion of  inflamed  veflels,  orx  in  other  words, 
the  proximate  caufe  of  thofe  fymptoms 
N  'denominated  inflammation,  is  not  always 
.  ;he  fame.  Hence  arifes  a  confiderable  ihare 
pf  the  difficulty  attending  the  inveftigation 
of  proximate  caufes  in  general. 

43.  THE  phenomena  of  inflammation 
evidently  Ihow,  that  in  every  inflamed  part 
there  is  a  congeftion  of  blood,  in  a  greater 
or  lefs  degree.  This  is  very  confpicuous  in 
thofe  parts  of  the  body  where,  from  their 
fituation,  we  are  enabled  to  fee  the  change 
of  colour,  as  in  the  fkin  -,  but  more  efpeci- 
ally  the  tunica  conjunctiva  of  the  eye, 
where,  from  its  trafifparency,  and  the  white 
fubjacent  tunica  albuginea,  we  have  an  op- 
portunity of  feeing  clearly  the  commence-* 
ment  and  progrefs  of  inflammation* 


[     197     ] 

44«  THE  firfl  appearance  is  a  diftention 
of  fome  of  its  veffels  in  fuch  a  degree,  as 
to  allow  red  blood  to  pafs  where  ferum  only 
was  wont  to  circulate.  In  the  progrefs  of 
inflammation  more  veiTels  become  diftend- 
ed,  until  at  length  the  whole  eye  aflumes 
almoft  one  uniform  red  appearance. 

45.  Now,  on  what  peculiar  ftate  of  vef- 
fels does  this  diftention   depend  ?  Are  the 
powers    that   aft    in    propelling   the    blood 
from  the  larger  veflels  to  the  fmaller  ones 
increafed,  while  the  refifting  powers  of  the 
ultimate  branches  remain    the    fame   as   in 
health  ?    Or  have  the  ultimate  branches  un- 
dergone a  change  of  fuch  a  nature  as  to  yield 
to  the  ordinary  force  or  natural  vis  a  tergo 
of  the  larger  veflels  ? 

46.  THERE  are  good  reafons  for  believ- 
ing that  each  of  thefe  conditions  exifts  in  its 
turn  :    at  lead  the  methods  employed  with 
fuccefs  to  remove  inflammations  of  this  part 
lead  to  that  opinion.     FO'L  it  is  a  fad  well 


[     i98     1 

eftablifhed  in  the  treatment  of  thefe  coin- 
plaints,  that  the  fame  means  which  are  em- 
ployed in  the  cure  of  one  opthalmia  tend 
only  to  aggravate  another.  The  means 
generally  employed  in  thefe  cafes  are  fuch 
as  either  diminifh  action  or  increafe  tone  -, 
and  each  plan  of  treatment  is  fuccefsful  in.  its 
proper  cafe. 

47.  Now  what  has  been  faid  of  opthal- 
mia will  apply  to  hepatitis  and  other  inflam- 
mations. 

Thelivermay  be  inflamed  in  confequence 
of  external  injury.  In  fuch  cafes  it  is  pro- 
bable that  a  violent  and  ilrong  action  will 
take  place,  analogous  to  what  would  happen 
in  the  eye  from  the  prefence  of  an  extraneous 
body  -,  and  that  a  plan  of  treatment  evi- 
dently fedative  or  antiphlogiftic  is  moil 
likely  to  be  efficacious  in  both. 

48.  ON  the  other  hand,   the  fame  organs 
rriay  be  in  a  ftate  of  inflammation  without 
die  application  of' any  obvious  Simulating: 


E    199    I 

cauie.  In  the  eye,  experience  has  evinced 
that  this  kind  of  opthalmia  is  mod  fuccefs- 
fully  treated  by  bark,  and  fuch  external 
applications  as  tend  to  ftimulate  and  give 
tone  ;  evidently  fhowing  that  the  efTential 
character  of  that  inflammation  is  debility. 
And  further,  it  is  now  well  underftood  that 
an  inflammation  of  the  eye,  which  was  of 
the  active  kind  at  its  commencement, 
changes  in  its  progrefs  to  a  ftate  of  debility, 
and  yields  only  to  thofe  means  that  give 
tone  and  ftrength  to  the  part. 

49.  IT  is  of  importance  to  ourfubject  ta 
inveftigate  in  what  way  an  active  inflamma- 
tion degenerates  into  an  indolent  one. 

We  have  faid,  in  every  inflammation, 
there  is  fome  degree  of  congeftion  of  blood, 
and  confequently  diftention  of  veffels  :  if 
this  congeftion  be  relieved  at  its  commence- 
ment, by  lefTening  the  diflending  caufe,  the 
vefTels,  ftill  preferving  their  tone,  readily 
return  to  their  original  dimenfions  ;  but  if,. 


[      200      ] 

on  the  other  hand,  the  congeftion  is  allow- 
ed to  remain,  and  of  courfe  the  diftention 
of  the  veflels,  their  tonic  power  neceflarily 
becomes  diminifhed,  and  fuch  means  only 
can  avail,  as  tend  to  lefien  the  column  of 
the  blood,  and  increafe  the  contractile  power 
of  its  veflels. 

Thefe  reafonings  may  ferve  to  give 
fome  idea  of  the  two  ftates  of  the  veflels 
as  conne&ed  with  active  and  indolent  in- 
flammation. 

50.  As  the  principles  laid  down  apply  to 
inflammations  of  any  organ,   we  ihall  en- 
deavour to  fhow,    by  canfidering   the  na- 
ture of  remote  caufes,   in    what  way    they 
may  produce  this   flate  of  veflels   in    he- 
patitis. 

51.  MANY    remote   caufes  of    hepatitis 
may  be   enumerated,    fuch   as  affections  of 
the  mind,  particularly  anger,  long  protract- 
ed  fumrner   heat,    the    intemperate  ufe  of 
fpirituous   liquors,    &c,      But   to  produce 


[      201      ] 

the  fame  difeafe  it  is  natural  to  expect  that 
there  is  one  principle  of  action  in  common 
to  them  all.  This  principle  appears  to  con- 
fift  in  inducing  a  ftate  of  excitement  in  the 
circulation  of  the  liver  :  the  accelerated, 
though  imperfect,  fecretion  of  bile,  toge- 
ther with  the  fenfe  of  fuln-efs  in  the  region 
of  the  liver  antecedent  to  inflammation, 
tend  to  perfuade  us  that  hepatitis  is  gene- 
rally ulhered  in  by  fymptoms  of  exifting 
congeflion. 

52.  IF  proper  methods  be  taken  to  re- 
lieve this  congeflion  on  its  firft  attack,  fuch 
as  diminifliing  the  column  of  blood,  or 
inducing  a  determination  of  it  to  conti- 
guous .parts,  the  tone  of  the  vefTels  will  be 
preferved,  and  evident  inflammation  pre- 
vented. Or  even  if  an  obvious  inflamma- 
tion has  commenced,  the  fame  means  will 
be  equally  ferviceable  by  allowing  the  dif- 
tended  vefTels  to  recover  that  tone  which 
they  were  beginning  to  lofe.  But  if  the 


[      202      ] 

congeftion  has  been  of  fome  duration,  and 
the  tonic  ftate  of  the  veflels  confiderably 
impaired,  if  the  moft  aftive  means  are  not 
employed,  the  confequenee  will  be  either 
a  fuppuration,  if  the  inflammation  be  vio- 
lent, or  a  degeneracy  into  fchirrus,  if  the 
inflammation  has  been  moderate  :  and  it  is 
in  this  way,  I  conceive,  that  an  inflamma- 
tion of  the  liver,  which  was  of  the  aclive 
kind  at  its  commencement,  changes  in  its 
progrefs  into  a  ftate  of  fchirrofity. 

53.  OR,  a  ftate  of  fchirrus  may  be  gra- 
dually induced  on  the  liver,  without  any 
pre-exifting  active  inflammation,  as  hap- 
pens after  a  long  refidence  in  a  warm  cli- 
mate, where,  from  frequent  accelerated 
fecretion  of  bile,  the  hepatic  veflels,  j  but 
more  efpecially  the  branches  of  the  vena 
portarum,  become  fo  relaxed,  that  they 
effufe  into  the  parenchymatous  fubftance 
of  the  liver  that  folid  matter,  which  appears 
to  be  nothing  more  than  the  coagulable 


I   203   ] 

lymph  of  the  blood  changed  in  a  peculiar 
way.*  This  is  the  morbid  ftrufture  of  the 
liver,  which  generally  terminates  in  afcites. 
54.  BUT  there  is  an  appearance  fome- 
times  met  with  on  difieftion  that  is  per- 

*  DROPSY  is  a  very  general  confequence  of  a 
difeafed  liver  ;  which,  from  previous  inflammati- 
on, may  have  fuffered  in  its  ftruclure  in  fuch  a 
way  as  to  produce  a  confidcrable  impediment  to 
the  tranfmiflion  of  blood  by  the  vena  portarum. 

Such  dropfles  fometimes  firft  manifeft  them- 
felves  by  water  in  the  abdomen,  at  others  by  a  fluid 
in  the  cellular  membrane.  Now,  as  both  of 
thefe  originate  from  the  fame  caufe,  it  may  de- 
ferve  inquiry,  to  what  circumftances  we  ihould 
impute  this  apparent  want  of  uniformity  in  na- 
ture. 

This  explanation  muft  be  fought  for  in  the  laws 
of  the  circulation.  Whatever  {hare  a  diminifhed 
action  of  the  abforbent  fyftem  may  have  in  pro- 
ducing an  accumulation  of  watery  fluids,  it  muft 
be  evident  that  a  confiderable  degree  of  effufioii 
from  the  exhalant  fyftem  is  eflentially  neceffary, 
and  which  excefs  of  effufion  can  arife  only  from 
an  excefs  of  vafcular  acYion. 

Admitting  this  pofition,  it  muft  follow  as  a  con- 
fequence, that  when  the  action  of  the  whole  ex- 
halant fyftem  of  the  body  is  increafed,  the  effu- 


[      204     ] 

haps  a  little  difficult  to  explain  on  this 
fyftem  of  reafoning — this  is  a  tubercular 
flate  of  the  fubftance  of  this  organ,  con- 
filling  of  a  feries  of  circumfcribed  inflam- 
mations, interfperfed  through  the  apparent 

HOD,  which  is  the  effect  of  it,  muft  be  as  exten-. 
five  as  the  caufe  :  and  on  the  contrary,  when  the 
accelerated  action  is  confined  to  a  part,  the  effufi- 
on  muft  likewife  be  equally  limited.  Now  are 
there  any  caufes  to  which  we  can  refer  this  exten- 
five  or  limited  action  ?  As  all  accelerated  action  is 
to  be  referred  to  ftimuli  of  fome  defcription,  we 
naturally  inquire  how  that  condition  of  vefiels 
can  be  produced  fometimes  in  "the  whole  exhalant 
fyftern,  fometimes  in  a  part. 

From  eftablifhed  laws  in  the  vafcular  fyftem, 
it  is  clear,  that  whatever  can  impede  the  free  paf- 
fage  of  the  blood  from  the  venous  fyftem  to  the 
right  fide  of  the  heart,  or  from  the  right  fide  of 
the  heart  to  the  left,  will  operate  as  a  ftimulating 
caufe,  and  produce  effects  on  the  exhalant  fyftem, 
either  limited  or  extenfive. 

To  fatisfy  ourfelves  reflecting  this  point,  we 
need  only  comprefs  a  principal  vein  either  of  the 
upper  or  lower  extremity,  at  the  fame  time  allow- 
ing the  artery  to  remain  free.  The  effect  of  this 
experiment  will  be,  that  the  veins  below  the  preff- 
ed  part  immediately  become  diftended,  the  lirnb 


healthy  fubftance  of  it.  Now  it  may  feem 
a  little  difficult  to  underftand  how  an  ac- 
celerated circulation  through  the  whole 
fubftance  of  the  liver  can  produce  effects 
fo  partial  and  circumfcribed.  But  the  dif- 

fcmetime  after  becomes  enlarged,  and  if  prefled 
upon  with  the  finger,  is  proved  to  be  evidently  in 
a  ftate  of  oedema. 

Let  us  inquire  what  operations  have  taken  place 
to  which  we  can  refer  thele  effects. — It  is  evident,, 
that  the  return  of  venous  blood  was  firft  impeded 
by  preffure,  and  that  a  refiftance  was  formed  to 
the  action  of  the  arteries,  the  ordinary  efforts  of 
which  are  now  become  infufficient  to  propel  the 
blood  with  its  wonted  velocity;  hence  a  neceffity 
for  greater  exertion  of  the  arterial  fyftem  to  fur- 
mount  the  difficulty  :  but  as  the  exhalants  form  a 
part  of  this  fyftem,  and  partake  of  the  general 
effect,  an  effuiion  of  their  watery  contents  fol- 
lows as  a  confequence  ;  hence  the  oedema,  or  in 
other  words,  a  local  dropfy. 

The  production  of  the  effect  juft  ftated  does  not 
argue  or  fuppofe  any  previous  difeafe  either  in  the 
exhalants  or  abforbents,  but  arifes  from  the  con- 

>curring  operation  of  two  caufes,  (viz.)  an  impe- 
diment to  the  return  of  venous  blood,  and  the 
confequent  accelerated  action  of  the  capillary  and 

%xhalant  fyftems.     And  it  ought  further  to  be  re- 
T 


[      206      ] 

ficulty  is  no  greater  in  this  cafe  than  in 
any  other  of  local  inflammation.  Do  we 
not  continually  fee  inftances  of  circtim- 
fcribed  inflammations  and  abfcefles  where 

the  ftate  of  the  circumjacent  parts  is   natu- 

• 

marked,  that  as  the  remote  caufe  was  limited  to 
a  particular  part  of  the  body,  fo  was  the  effect 
produced  by  it. 

Let  us  n9\v  transfer  this  reafoning  to  the  liver, 
and  fee  how  far  an  impediment  to  the  free  paf- 
fage  of  blood,  through  that  organ,  may  operate 
towards  the  production  of  afcites. 

That  ftate  of  the  liver,  which  more  particularly 
difpofes  to  this  difeafe,  is  the  fchirrous  or  indurat- 
ed one:— that,  which  when  examined  by  making 
ilices  of  it,  manifefts  a  folid  and  clofe  compacted 
mafs,  as  if  there  had  been  deposited  interftitially 
within  its  fubftance,  folid  matter  fufficient  to  def- 
troy  its  parenchymatous  character.  Indeed  the 
fact  feems  very  evident,  that  its  veffels  are  lefs 
pervious,  and  confequently  that  the  blood  cannot 
be  tranfmitted  by  them  fo  freely  as  in  a  ftate  of 
health. 

Now  in  a  former  part  of  this  work  we  endea- 
voured to  make  it  probable,  that  the  indurated 
or  fchirrous  condition  of  the  liver  depended  more 
on  a  difeafed  action  of  the  vena  portarum  than  of 
the  arterial  fyftem  of  this  gland  j  and  that  when 


[    207    ] 

ral  and  healthy  ?  Such  phenomena  do  not 
tend  to  difprove  the  principles  we  wifh  to 
eftablifb,  but  fhow  that  the  difeafed  condi- 
tion of  veflels  we  have  before  pointed  at, 
may  exift  in  a  number  of  fmall  parts  of 

an  inflammation  arofe  in  this  way,  it  was  to  be  re- 
garded rather  as  of  the  paffive  than  of  the  active 
kind  ;  or  a  fpecies  but  little  difpofed  to  terminate 
in  fuppuration.  Its  effects  are  rather  thofe  that 
characterize  indolent^  parts,  fuch  as  induration, 
fchirrofity,  &c.  But  this  confequence  neceffaii- 
ly  enfues,  that  though  venous  inflammation  has 
not  activity  enough  to  produce  pus,  it  has  power 
to  effufe  the  coagulable  lymph  of  the  blood  into 
the  interftitial  parts  of  the  liver,  and  thereby  di- 
minifli  the  capacities  of  the  blood  veflels,  more  ef- 
pecially  of  the  vena  portarum  :  and  thus  an  im- 
pediment .to  the  free  paffage  of  blood  through 
that  fyftem  is  formed. 

Having  thus  fhown  the  probability  of  an  ob- 
ftruction  exifting  to  the  paflage  of  the  blood 
through  the  liver,  in  what  manner  does  this  bear 
a  refemblance  to  the  effects  of  a  ligature  on  the 
principaf  vein  of  an  extremity  ? 

Before  we  can  anfwer  this  queftion,  we  muft 
recall  to  the  attention  of  our  readers  wiiat  has 
been  faid  in  a  former  part  of  this  work  on  the 
fubjeft,  relative  to  the  circulation  of  blood  through 

rn      O 


[    ao8    ] 

any  organ,  while  the  greater  part  of  its 
bulk  ihall  be  in  a  natural  ftate ;  or  that 
there  may  exift  a  confiderable  number  of 
itimulating  caufes  in  the  fubftance  of  the 
liver,  each  having  its  own  fphere  of  action, 
and  each  limited  in  its  extent.. 

the  chylopoietic  organs.  There  it  was  remarked, 
that  the  blood  which  had  circulated  through  the 
ftomach  and  inteftines,  omentum,  fpleen,  and 
pancreas,  and  we  may  likewife  add,  the  perito- 
neal covering  of  thefe  vifcera,  was  returned  to 
the  heart  by  the  intervention  of  the  vena  porta- 
rum  of  the  liver  :  therefore  it  follows,  that  the 
circulation  of  blood  through  this  vifcus  ftands  in 
the  fame  relation  to  the  peritoneal  vifcera  as  the 
returning  blood  in  the  principal  vein  of  an  extre- 
mity does  to  that  particular  limb  ;  and  likewife 
it  muft  follow  of  neceility,  that  whenever  the 
liver  is  affected  with  any  confiderable  degree  of 
fchirrofity,  the  circulation  through  the  vena  por- 
tarum  will  receive  fome  interruption.  That  in- 
terruption, in  whatever  degree  it  may  exift,  muft 
excite  the  capillary  veiTcls  and  exhalantsin  the  pe- 
ritoneal vifcera  to  greater  actions;  and  the  effufi- 
on  of  lymph  from  thofe  parts  follows  as  a  con- 
fequence.  Such  appears  to  me  to  be  a  rational 


55«  THE  explanation  juft  given  is  not 
offered  as  the  mere  fuggeflion  of  theory, 
but  admits  of  a  degree  of  probability  ap- 
proaching to  demonftration.  This  laft 
opinion  feems  flrongly  fupported  by  the 
refult  of  an  experiment  that  was  made  for 
the  purpofe  of  inveftigating  a  point  in 
phyfiology,  not  connected  with  the  prefent 
queftion. 


EXPERIMENT. 

56.  Two    drachms    of    crude    mercury 
were  injected  by   means  of  a  proper  sappa- 

explanation  of  afcites,  as  founded  on  a  fchirrous 
affection  of  the  liver. 

On  the  fame  principle  may  be  explained  the 
hydrothorax,  as  originating  in  the  excitement  of 
inflammation  in  the  cavity  of  the  cheft  ;  or  ia 
any  mechanical  obftacle  to  the  free  paflage  of 
Wood  ficm  rnefide  of  the  heart  to  the  other,  or 
fi  m  the  pr  ell  11  re  on  the  diaphragm  ariiing  from 
an  enlarged  liver,  or  an  ?Tcitic  dropfy. 
T  J 


[      210      ] 

ratus  into  the  crural  vein  of  a  dog.  It 
produced  no  efFe6ts  that  were  obvious  for 
at  leaft  a  whole  day  ;  but  afterwards  there 
were  evident  marks  of  increafed  action  in 
the  vafcular  fyftem,  attended  with  a  quick 
and  hard  pulir.  After  he  had  continued 
in  this  ftate  two  or  three  days,,  a  dyfpncea 
fupervened  -,  this  was  foon  followed  by  a 
cough,  and  fymptoms  evidently  denoting 
an  affection  of  the  lungs,  which  daily  in- 
creafed until  he  died.  His  lungs,  on  ex- 
amination, were  found  in  a  tubercular  (late  ; 
many  of  thefe  tubercles  had  fuppurated  and 
formed  vomicas. 

57.  THE  que'flion  here  is,  whether  thefe 
tubercles  and  vomicse  arofe  from  the  intro- 
duction of  the  mercury  ? 

The  anfwer  is  very  clear.  The  animal 
was  in  perfect  health  before.  This  is  only 
a  preemptive  evidence.  But  a  minute  ex- 
amination of  the  tubercles  put  the  matter 
out  of  doubt ;  for  on  making  feet  ions  into 


the  fubfiance  of  them,  each  contained  & 
globule  of  mercury,  forming  a  kind  of 
nucleus  to  the  circumfcribed  inflammation 
or  tubercle.  Whether  thefe  mercurial  glo- 
bules afted  on  the  principle  of  fimple 
flimuli,  or  in  a  fpecific  way,  is  not  a  fubject 
for  our  prefent  investigation  :  but  the  in- 
ference intended  to  be  drawn  is,  that  fymp- 
toms  of  general  excitement  may  exift  in  the 
whole  body,  and  that  only  a  particular 
organ  may  fhow  marks  of  difeafe  -y  and 
further,  that  the  circulation  may  be  accele- 
rated through  the  whole  vafcular  fyftem 
of  a  particular  organ,  while  only  particular 
parts  of  that  organ  fuffer  a  vifible  alteration 
in  their  ftructure. 

58.  Now  it  is  natural  to  refer  thefe  ap- 
pearances to  fome  local  caufe,  but  which  is 
not  always  fo  evident  as  in  the  experiment 
juft  recited.  This  caufe  may  confiil  iiv 
local  alterations  in  the  tone  of  the  veflels 
in  particular  parts  of  an  organ  ;  and  thaty 


C      212      ] 

in  confequenceof  an  accelerated  circulation 
through  its  whole  fubftance,  thefe  debilitat- 
ed parts  may  readily  fall  into  a  ftate  of 
chronic  inflammation. 

59.  IN  confidering  the  active  and  indo- 
lent   inflammations  of  the    liver,  we  have 
referred   the   former  to  the   hepatic  artery 
or   nutrient    vefTel  ;    while    the    latter   has 
been  confidered  as  an  affection  of  its  fecre- 
tory  vefTel.     As  this  opinion   is  not   taken 
up  on  the   ground  of  mere  conjecture,   it 
will  not  be  out  of  place  to  affign  a  reafon 
for  having  adopted  it. 

60.  WHEN  we  ftate  that  chronic  inflam- 
mations of    the   liver   appear   to   be    con- 
nected with  its  fecretory  office,    we   do   not 
mean  to  reft  the  explanation  on   any    thing 
fpecific  in  its  fecretory  energy,   but  on    its 
peculiarity  of  having  the  fecretion  effected 
from  venous  blood  inftead  of  arterial. 

61.  IT  is  a  faft  well  eftablifhed  in  phy-" 
ilology,  ,that  the  living  power   or  energy 


of  any  organ  is,  casteris  paribus,  in  pro- 
portion to  the  quantity  of  arterial  blood 
that  circulates  through  it.  There  is  fome- 
thing  then  in  the  condition  of  arterial  blood 
that  fits  an  organ  for  active  and  vigorous 
purpofes  ;  the  proofs  of  this  pofition  arc 
fo  numerous,  that  they  mult  occur  to  every 
one.  Now  when  we  recollect  that  by  far 
the  greater  portion  of  blood  that  pafTes 
'through  the  liver  is  of  the  venous  kind, 
and  when  it  is  remembered  likewife  that 
this  blood  is  lefs  fitted  to  aflive  purpofes 
than  arterial,  there  will  appear  fufficient 
grounds  for  believing  that  chronic  inflam- 
mations of  the  liver  are  to  be  referred  to  the 
vena  portarum  ;  while  thofe  of  the  active 
kind  are  imputable  to  the  hepatic  artery. 

62.  IN  the  active  and  acute  inflamma- 
tion of  the  liver,  as  well  as  that  of  other 
organs,  the  antiphlogiilic  practice  fliould 
be  adopted  j  and  as  the  attention  of  the 
practitioner  ihould  be  directed  to  the  pre- 


vention  of  fuppu ration,  he  muft  be  guided 
by  the  circumftances  of  each  individual 
cafe  in  forming  bis  judgment  to  what  ex- 
tent that  practice  may  be  purfued.  Here 
much  depends  on  his  difcernment,  as  well 
refpecting  the  extent  of  the  antiphlogiilic 
practice,  as  in  determining  the  preciie  pe- 
riod when  it  is  likely  to  be  mod  ufeful  : 
for  it  mud  be  obvious,  that  if  any  confi- 
derable  advantage  is  to  be _  expected  from 
this  practice,  it  mud  be  locked  for  in  an 
early  itage  of  the  difeafe,-  when  the  inflam- 
mation has  not  advanced  beyond  the  proba- 
bility of  refolution. 

63.  THE  more  prominent  part  of  the 
antiphlogiftic  treatment  is  blood-letting  : 
the  quantity  of  blood  to  be  taken  away, 
together  with  the  propriety  of  repeating 
that  operation,  can  be  judged  of  only  by 
the  violence  of  fymptoms,  by  the  effecl: 
upon  the  pulfe,  and  by  the  circumftances 
of  each  individual  cafe. 


64.  BLISTERS,  applied   to  the  region  of 
the '  liver,     co-operate   very   flrongly   with 
the  views  of  blood-letting,    and   therefore, 
in   attempting  refolution,    recourfe   fhould 
be  had  to  them  very  early  $  and  here  again 
the  fame  difcrimination  is    necefTary   with 
refpect  to  their  duration  and  repetition,   as 
was  required  in  the  cafe  of  blood-letting. 
It  has  been  advanced  by  fome,   and  experi- 
ment appears  to  have  juftifled  the  pofition, 
that  a   quick   fucceffion  of  blifters  to  the 
vicinity  of  an  inflamed  organ  prevails  more 
over  the  activity  of  inflammation,   than  the 
long  protra&ed   difcharges   from   a   fingle 
vefication.       My    own    experience   having 
abundantly  confirmed  the  truth  of  this  doc- 
trine, I  cannot  recommend  it  to  the  practi- 
tioner in  too  ftrong  terms. 

65,  As  fubfervient   to  the  intention   of 
refolution,     medicines     promoting     alvine 
evacuations  'are  highly  expedient  ;    for  this 
purpofe,  thofe  which  are  of  a  faline  nature 


[     216     ] 

appear  to  me  to  claim  a  preference,  and 
perhaps  it  is  adding  not  a  little  to  their 
efficacy  to  exhibit  them  in  a  diluted  form, 
in  which  ftate  they  not  only  feem  to  be 
more  ftrictly  antiphlogiftic,  but  are  lefs 

liable    to  occafion   naufea   and  other     dif- 

<iy 

agreeable  fenfations  in  the  ftomach. 

66,  IN  blood-letting,  blifters,  and  lax- 
ative medicines  appear  to  confiit  the  more 
eflcntial  parts  of  antiphlogiftic  practice ; 
but  there  are  other  refources  of  which  we 
can  avail  ourfelves,  and  which,  though 
fubordinate  in  point  of  activity,  are  found 
from  practice  to  be  very  efficacious  as 
auxiliaries.  Under  this  head  we  may  rank 
antimonials  exhibited  in  fuch  dofes  as  may 
tend  to  produce  and  continue  a  degree  of 
foftnefs  and  moiiture  upon  the  fkin  5  and 
this  operation  of  antimonials  is  much 
aided  by  a  free  and  plentiful  ufe  of  dilut- 
ing liquors,  of  which  there  is  an  endlefs 
variety. 


€7.  BY  the  means  above  recited,  the 
practitioner,  if  called  in  at  the  commence- 
ment of  the  difeafe,  will  generally  be  able 
to  check  every  tendency  to  the  fuppurative 
procefs. 

68.  IN   warm  climates,    more   efpecially 
in   the  Eaft  Indies,   where  hepatitis  may  be 
regarded  as  the   endemia   of  the   country, 
the  tendency  to  run  on   into  the  fuppura- 
tory  procefs  is  fo   great  as   fcarcely   to  be 
refilled  even  by  the  moft  active  practice  -, 
therefore,    if  an  early  and  vigorous  purfuit 
of  the    antiphlogiftic   plan  of  treatment  be 
neceflary  in  this  country,    where    the  courfe 
of  the  difeafe  is  comparatively    moderate ; 
the    extenfion    of  fuch    treatment     to   the 
utmoft  limits  of  prudence,    becomes  expe- 
dient, if  we  would  oppofe  with  fuccefs  the 
rapidity  of  its  progrefs. 

69.  IF,    either  from  an   unufual  violence 
of    the    difeafe,     the    too   late    application 
for  medicinal   afliftance,    or   the  unavailing 


[      218     ] 

efforts  of  the  antiphlogiftic  plan  of  treat- 
ment, the  inflammation  fhall  have  pro- 
ceeded to  the  fuppurative  flage,  different 
phenomena  occur,  according  to  the  partu 
cular  part  of  the  liver  in  which  the  fup- 
puration  is  feated.  Thefe  phenomena  are 
fuch  as  arife  out  of  the  laws  which  regulate 
the  opening  of  abfceffes :  for  the  operation 
of  nature  in  this  refpect,  as  well  as  in  moft 
others,  is  regular  and  uniform. 

70.  FROM  obfervatioh  we  learn,  that 
hepatic  abfcefles  fometimes  open  fpontane- 
ouily  into  the  inteftinal  canal  in  the  manner 
explained,  at  fome  length,  in  a  former  part 
of  this  work  j  at  others,  they  make  their 
way  through  the  diaphragm  into  the  air 
cells  of  the  lungs,  from  whence  the 
matter  is  difcharged  by  expectoration  -,  or 
an  adhefion  takes  plac?  between  the  ante- 
rior furface  of  the  liver  and  the  parietes 
of  the  abdomen,  allowing  the  pus  to 
make  its  efcape  by  the  common  integu- 
ments. 


?i.  EACH  of  thefe  channels  of  difcharge 
is  determined  very  much  by  the  particular 
feat  of  the  abfcefs.  When  the  pofterior  or 
concave  furface  is  concerned,  the  matter 
ufually  paffes  off  by  fome  part  of  the  in- 
teftinal  canal,  frequently  the  duodenum ; 
but  when  it  is  feated  towards  the  inferior 
edge,  the  colon  offers  a  ready  outlet.  When 
the  fuperior  pordon  iuppurates,  the  air 
cells  of  the  lungs  favour  the  efcape  ;  and 
fuc'i  abfceffes  as  form  towards  the  anterior 
furface,  ufually  extend  thcmfelves  to  the 
integuments,  through  which  they  cither 
difcharge  their  contents  fpontaneoufly,  or 
by  the  aid  of  chirurgical  means. 

72.  THE  intention  of  nature  in  relieving 
herfelf  by  thefe  different  channels  is  the 
fame,  as  fhe  is  guided  by  one  common 
principle  in  each  of  them,  viz.  that  of 
availing  herfelf  of  the  neareft  outlet.  But 
experience  has  evinced  that  thefe  are 
not  all  equally  favourable  to  her  ultimate 

u  3 


[      220      } 

views;  and  fome  hepatic  abfcefTes,  which 
have  been  difcharged  by  the  lungs,  appear 
to  have  produced  their  fatal  effects  more 
•from  an  extenfion  of  fuch  abfceffes  into 
the  fubftance  of  thefe  organs,  than  from 
any  derangement  the  con-ftitution  .had  fuf- 
tained  from  the  affection  of  the  liver.  I 
feel-  myfeif  warranted  the  more  in  main- 
taining this  idea,  not  only  from  having 
repeatedly  feen  the  fymptoms  of  hepatitis, 
in  its  latter  ilage,  evidently  transformed 
into  the  characters  of  peripneumony ;  but 
from  having  afcertained,  by  examination 
after  death,  that  a  fuppurating  furface, 
which  originated  in  the  liver,  extended 
itfelf  into  the  fubftance  of  the  lungs  in 
fuch  degree,  as  clearly  to  explain  the  caufe 
of  the  peripneumonic  fymptoms. 

73.  THE  difcharge  of  hepatic    abfcefTes, 
either  by    the  inteftines  or    the    abdominal 
furfaee,  is  much  preferable,   as  in  the  for- 
mer, the  organ,  though  important  and  even 
•vital,    is  affected   only  to   a  fmall   extent.; 


[      221       ] 

and  in  the  latter,  very  little  danger  can 
arife  from  an  opening  of  a  moderate  fize. 
What  occafions  our  furprife  is,  that  they 
fo  feldom  effufe  their  contents  into  the  ca- 
vity of  the  abdomen.  The  law  itfelf  is 
wonderful,  though  the  means  by  which  na- 
ture carries  her  intentions  into  effect  are  very 
obvio.us  j  for  in  all  thefe  cafes  the  opening 
is  furrounded  by  adhefions  fo  effectually, 
that  there  is  little  danger  of  the  general  ca- 
vity being  expofed. 

74.  IF,  however,  the  difeafe  is  well 
marked,  and  the  abfcefs  has  pointed  to  a 
determined  part  of  the  integuments,  we 
need  not  wait  for  a  fpontaneous  opening, 
but  by  means  of  a  lancet  may  difcharge 
the  matter.  Such  abfcelfes  are  feldom  in 
hafte  to  heal,  nor  is  it  defirable,  until  the 
cavity  of  the  abfcefs  (hall  have  been  filled 
up  by  healthy  granulations.  During  this 
procefs,  which  is  fometimes  tedious,  the 
health  gradually  returns  3  and  I  have  had 
v  -3 


[      222      ] 

experience  of  cafes  where  the  difcharge  ac- 
companying this  granulating  operation  was 
continued  for  years,  during  which  time  the 
health  was  in  a  progrefTive  Hate  of  amend- 
ment, and  at  length  was  perfectly  eftab- 
lifhed. 

75.  Sucn  infbances,  though  furprifing, 
are  not  myfterious,  for  a  part  only  of  the 
liver  has  been  concerned  in  the  abfcefs. 
During  the  period  of  active  inflammation, 
the  conftitution  partook  of  the  effects,  per- 
haps more  from  a  principle  of  fympathy 
with  the  inflamed  organ,  than  from  any 
derangement  in  its  economy  as  a  gland;, 
and  therefore  it  is  natural  to  expect,  that, 
as  the  inflammatory  fymptoms  fubfide,  the 
figns  of  health  fhould  return. 

76.  AN  opinion  has  for  fome  time  pre- 
vailed, that  mercury  is  a  fpecific  in  every 
difeafe  of  the  liver;  and  that  even  in  active 
phlegmonous  inflammations  it  will  obviate 
fuppuration.  This  opiniop  appears  to, have 


f    223   3 

been  founded  on  an  idea,  that  there  is  foine-* 
thing  very  peculiar  in  the  inflam; nation  of 
the  liver  that  is  not  met  with  in  any  other 


organ. 


77.  IT    is    true,   that    in    confidering  its 
glandular  office,  it  affords   an  exception  to 
the  law  of    glands,    in  having  its  fecretion 
performed    from   venous    blood ;    and  this 
we  have  already  confidered  as  having  a  con- 
nexion   with   chronic  inflammation,    which 
experience  has  fhown    to   be   relievable  by 
mercury.     The  fuccefs  in  thefe  cafes  has  per- 
haps led  to  an  empirical  practice,    and  due 
difcrimination    may  not    always  have  been 
made    between    inflammations  of    a   more 
indolent,   and  'fuch  as  are  of  a  more  active 
nature. 

78.  To    exhibit  a  remedy  without   due 
difcrimination  is  to  abufe  it,  and  at   length 
to  bring  it  into  neglect;     and  in    this  way 
the  world  has  been  deprived,    for  a   time, 
of  the  benefit  of  fome  of  the  mod  valuable 


[    224    ] 

articles  of  the  materia  medica,  which,  how- 
ever, have  been  reftored  to  them  afterwards, 
on  the  recommendation  of  men  of  candour 
and  ability,  after  having  determined  their 
true  value  by  repeated  and  judicious  exhi- 
bition. 

79.  PERHAPS  the  fame  fate  may  await  the 
ufe  of  mercury  in  complaints  of  the  liver, 
if,  by  a  blind  empirical  adrniniftration  of  it, 
it  be   incautioufly  employed  in  the   active 
periods  of   inflammation,   when,    from  its 
ftitnulant  properties,    it  appears  better  cal- 
culated to  accelerate  than  to  retard  the  fup- 
purative  procefs. 

80.  IT  is  very  probable,   that  the  attach- 
ment of  the  practitioners  in  warm  climates 
to  the  early  ufe  of  mercury,  may  havearifen 
in  part  from  the  great  debility  confequcnt 
on  the  previous  excitement  of  the   fyftem, 
which  debility  is  fuppofed   to  prevail   the 
moil-,  where  there  had  been  much  evacuati- 
on $  and  this  prejudice  has  perhaps  been  car-  - 


[      225      I 

ried  to  a  dangerous  extreme.  But  there  are 
not  wanting  fome,  who  are  perfectly  aware 
of  the  neceflityof  proper  diftinctions,  and 
who  pay  due  regard  to  them  in  their  prac- 
tice. 

8 1.  IN  theEaft  Indies,  where  this  com- 
plaint is  endemic,  I  am  informed,  on  the 
bed  authority,  that  many  judicious  and  fuc- 
cefsful  practitioners  feldom  adminifter  mer- 
cury until  the  violence  of  the  inflammato- 
ry action  has  been  moderated  by  bleeding, 
active  purging,  and  the  antiphlogiflic  plan 
of  treatment.  Then  it  is,  that  mercury 
is  employed  to  the  greateft  advantage.  But 
it  appears,  on  attentive  obfervation,  that 
the  tranfition  of  active  inflammation  into  a 
Hate  of  refolution,  is  not  immediately  fol- 
lowed by  a  healthy  condition  of  the  part, 
but  it  remains  for  a  time  debilitated  and 
diipofed  to  lapfe  into  a  chronic  Hate.  This 
will  probably  be  found  the  proper  period  for 
the  exhibition  of  mercury,  which  acts  as  a 


I  226  ] 

fpur  on  the  vafcular  fyftem  of  this  organ, 
and  by  its  moderately  Simulating  effects, 
occafions  a  degree  of  action,  which,  when 
protracted  to  a  proper  length,  terminates  in 
health. 

Si.  BUT  the  difpofition  of  hepatitis  to 
terminate  in  a  fchirrons  and  difeafed  ftruc- 
ture,  either  of  the  whole,  or  of  a  part  of 
the  liver,  is  fo  ftrong  in  fome  cafes,  as  not  to 
be  refitted  by  a  moderate  mercurial  action. 
Here  we  are  to  take  the  advantage  of  its 
more  active  operations ;  and,  inftead  of  in- 
ducing a  flight  change  upon  the  pulfe,  with 
only  a  tendernels  of  the  mouth,  we  ought 
to  extend  its  effects  to  the  production  of  a 
gentle  falivation,  which,  when  continued 
for  a  length  of  time,  generally  effects  a 
cure. 

83.  IN  the  exhibition  of  mercury  for 
this  purpofe,  a  preference  has  been  given 
to  friction ;  and  the  part  on  which  the 
mercurial  ointment  has  been  rubbed,  is 


[    2*7    ]    . 

the  right  hypochondrium,  from  a  notion 
of  .its  efficacy  being  greater  when  applied 
to  the  vicinity  of  the  difeafed  organ,  than 
to  a  diftant  part.  But  my  opinion  is,  that 
there  is  no  material  advantage  derived 
from  this ;  and  it  is  of  little  importance, 
what  part  is  made  choice  of,  provided  the 
effects  produced  on  the  general  fyflem  arc 
equally  ftrong. 

84.  THE  knowledge  we  derive  from  ana- 
tomy of  the  ftructure,  origin,  and  directi- 
on of  the  lymphatic  veflels,  fufficiently 
proves,  that  neither  by  the  internal  ufe  of 
mercury,  nor  by  its  external  application, 
can  any  of  it  be  made  to  pafs  through  the 
liver  in  its  way  into  the  conftitution  •>  it 
cannot,  therefore,  act  on  the  liver  but  by 
being  firft  introduced  into  the  blood  veflels. 
It  is  fome.times  difficult  in  cafes  of  difeafed 
liver,  efpecially  if  attended  with  dropfy, 
to  introduce  mercury  into  the  constitution  ; 
under  fuch  circumftances,  the  beft  abforb~ 


[      228      ] 

ing  furface  fliould  be  employed  for  the 
purpofe  of  fri&ion  :  fuch  parts  of  the  body 
as  have  the  fined  cuticle,  as  between  the 
fingers,  in  the  axilla,  or  groin,  abforb  mod 
readily,  and  if  the  cuticle  be  removed  by 
bliders,  from  any  part  of  the  body,  fuch 
a  furface  will  be  found  bed  adapted  to  the 
purpofe  of  abforption.  Ulcers  frequently 
abforb  better  than  entire  furfaces,  and  in 
many  cafes  fuch  artificial  means  of  pro- 
moting abforption  may  be  admitted. — It 
is  likewife  a  fubjed  worth  confidering, 
whether  dill  greater  advantage  can  be 
derived  from  the  introduction  of  active 
and  chymical  preparations  of  mercury  by 
abforption  than  by  the  ufe  of  the  common 

mercurial    ointment. Ulcerated    furfaces 

•will  abforb  the  faline  preparations  of  mer- 
cury, while  a  furface,  covered  with  a  cu- 
ticle, would,  with  difficulty,  admit  them. 
The  quantity  of  mercury,  at  any  one  time, 
in  a  date  of  adion  in  the  body,  is  fo  fmall 


3 

as  to  elude  all  the  powers  of  chymical 
inquiry.  By  various  and  accurate  tefts,  I 
have  not  difcovered  .in  the  fecretions  any 
mercury  in  perfons  under  a  falivation, 
either  from  the  internal  or  external  ufe  of  it. 
85.  THE  fchirrofity,  which  we  have 
been  confidering  as  the  remains  of  hepa- 
titis, is  often  very  intimately  connected 
with  other  difeafes ;  and  is  thought  by 
men  of  obfervation  and  experience,  to 
fland  in  relation  to  them,  as  a  caufe. — 
Thus  in  India,  the  fever  and  dyfentery, 
which  are  confidered  as  the  endemias  of 
the  country,  have  been  found,  on  direction, 
to  be  accompanied  with  difeafes  of  the 
liver.  In  fome  inftances,  the  whole  fub- 
ftance  has  been  in  a  fchirrous  ftate  j  in 
others,  abfcefles  and  the  ufual  appearances 
of  hepatitis  have  been  met  with :  the  fa<5t 
is  certain,  though  the  relation  in  which 
they  are  placed  to  each  other  may  be  matter 

of  opinion. 

x  - 


[     230 

86.  IF  it  be  true,  and  there  can  be  but 
little  room  for  doubt,  that  every  difeafe  of 
a  gland  mud  affect,  in  fome  degree  or 
other,  its  fecretory  powers,  we  may  admit, 
that  the  biliary  fecretion  may  become 
extremely  vitiated,  may  acquire  acrid  pro- 
perties, and  may  morbidly  affecl:  the  in- 
teftinal  canal  by  its  paflage  through  it  j 
hence  may  follow  ulcerations  of  the  inter- 
nal furface,  giving  rife  to  the  common 
fymptoms  of  dyfentery.  But  if  it  be  an 
eilabliflied  fact,  as  has  been  aflerted  by 
high  authority,  that  the  dyfentery  is 
always  contagious  ;  there  would  feem  to 
be  a  nece/Iity  for  calling  in  fome  other 
principle  of  action,  in  addition  to  the 
acrimony  of  the  bile.  But  waving  this 
controverfy,  which  cannot  be  protracted 
to  a  greater  length*  without  evidently 
digrefling  from  the  main  purpofe  of  this 
chapter,  it  is  in  place  here  to  obferve,  that 


thefe  dyfcnteries  are  fo  far  congenial  to  the 
hepatic  affe&ions  with  which  they  are  com- 
bined, that  they  are  generally  relieved  by 
mercury  administered  under  the  cautions 
we  have  already  laid  clown. 


>    I    N    I    S, 


